Healthcare Provider Details

I. General information

NPI: 1710416094
Provider Name (Legal Business Name): DEANNA BARBARA ANDERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 S SILICON WAY STE A
ST. GEORGE UT
84770
US

IV. Provider business mailing address

1492 S SILICON WAY STE A
ST GEORGE UT
84770-7156
US

V. Phone/Fax

Practice location:
  • Phone: 435-275-8911
  • Fax: 435-200-9442
Mailing address:
  • Phone: 435-275-8911
  • Fax: 435-200-9442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: