Healthcare Provider Details

I. General information

NPI: 1235963018
Provider Name (Legal Business Name): MEGAN C VANROOSENDAAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 S REDWOOD RD
WEST JORDAN UT
84084-4007
US

IV. Provider business mailing address

7601 S REDWOOD RD BLDG E
WEST JORDAN UT
84084-4007
US

V. Phone/Fax

Practice location:
  • Phone: 801-233-8670
  • Fax:
Mailing address:
  • Phone: 801-233-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14223346-6006
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number14223346-6006
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: