Healthcare Provider Details

I. General information

NPI: 1841177730
Provider Name (Legal Business Name): SAMANTHA TRUSENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 S 3200 W STE 2
WEST JORDAN UT
84084-2887
US

IV. Provider business mailing address

245 S 1300 W
SLC UT
84104-2325
US

V. Phone/Fax

Practice location:
  • Phone: 801-915-0359
  • Fax:
Mailing address:
  • Phone: 801-915-0359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12525480-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: