=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922345453
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENA JEAN VANZO MS, LCGC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2013
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10927 S WOOD STONE CR
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-747-2662
-----------------------------------------------------
Fax | 801-453-6810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10927 S WOOD STONE CR
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-313-0746
-----------------------------------------------------
Fax | 801-453-6810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 170300000X
-----------------------------------------------------
Taxonomy Name | Genetic Counselor (M.S.)
-----------------------------------------------------
License Number | 7044096-3601
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------