Healthcare Provider Details

I. General information

NPI: 1477003259
Provider Name (Legal Business Name): ANDREW LINDSAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 770 N
OREM UT
84097-4101
US

IV. Provider business mailing address

1301 ALPINE WAY
PROVO UT
84606-5392
US

V. Phone/Fax

Practice location:
  • Phone: 801-800-0187
  • Fax:
Mailing address:
  • Phone: 801-800-0187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12476876-3502
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier1477003259
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: