Healthcare Provider Details

I. General information

NPI: 1346052396
Provider Name (Legal Business Name): NATALEE ANGELI LSUDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7181 S CAMPUS VIEW DR STE 1A
WEST JORDAN UT
84084-4312
US

IV. Provider business mailing address

5722 N ABERDEEN LN
TOOELE UT
84074-9667
US

V. Phone/Fax

Practice location:
  • Phone: 801-613-9843
  • Fax:
Mailing address:
  • Phone: 435-241-2819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12896567-6006
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: