Healthcare Provider Details

I. General information

NPI: 1912820465
Provider Name (Legal Business Name): ROSEMARIE RENAUD ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSEMARIE RENAUD EVANS M.ED.

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 S MAIN ST
SALT LAKE CITY UT
84115-1911
US

IV. Provider business mailing address

3846 E SUNNYDALE LN
SALT LAKE CITY UT
84108-1523
US

V. Phone/Fax

Practice location:
  • Phone: 385-528-2950
  • Fax:
Mailing address:
  • Phone: 801-828-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14268659-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: