Healthcare Provider Details

I. General information

NPI: 1427887298
Provider Name (Legal Business Name): AMY JANE SONDRUP CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S 1350 W STE F30
OREM UT
84058-3873
US

IV. Provider business mailing address

1111 S 1350 W SUITE F30
OREM UT
84058-3873
US

V. Phone/Fax

Practice location:
  • Phone: 801-979-6304
  • Fax:
Mailing address:
  • Phone: 801-979-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11774281-3502
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: