Healthcare Provider Details

I. General information

NPI: 1346229713
Provider Name (Legal Business Name): ANNA MARIE ROUMPOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ANNA MARIE WONDOLOWSKI LCSW

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 GUARDSMAN WAY
SALT LAKE CITY UT
84108-1374
US

IV. Provider business mailing address

780 GUARDSMAN WAY
SALT LAKE CITY UT
84108-1374
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-0194
  • Fax: 801-581-0193
Mailing address:
  • Phone: 801-581-0194
  • Fax: 801-581-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3645073501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number3645073501
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier9429384884108A004
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerCHAMPUS
# 2
Identifier591448
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerDESERET MUTUAL
# 3
Identifier107003856101
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerINTERMTN. HEALTH CARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: