Healthcare Provider Details

I. General information

NPI: 1033769682
Provider Name (Legal Business Name): ANI ZAKARYAN CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 26TH ST STE 100
OGDEN UT
84401-2459
US

IV. Provider business mailing address

533 26TH ST STE 100
OGDEN UT
84401-2459
US

V. Phone/Fax

Practice location:
  • Phone: 307-349-8521
  • Fax: 801-459-1200
Mailing address:
  • Phone: 307-349-8521
  • Fax: 801-459-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10858667-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: