Healthcare Provider Details

I. General information

NPI: 1174091532
Provider Name (Legal Business Name): BRANDEE ZIRA HANSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 W 1200 N STE 400
SPRINGVILLE UT
84663-3080
US

IV. Provider business mailing address

12569 S 2700 W
RIVERTON UT
84065-7182
US

V. Phone/Fax

Practice location:
  • Phone: 801-209-9797
  • Fax: 801-206-3506
Mailing address:
  • Phone: 801-209-9797
  • Fax: 801-206-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13444582-3502
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: