MEDICARE: ANDELYN ROBERTS ROGERS ACMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	14259874-6009	UT

General Provider Information

NPI Number	:	1194667295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDELYN ROBERTS ROGERS ACMHC

Provider Business Mailing Address
First Line	:	10730 S LAKE RUN RD UNIT 3318
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-1872
Country	:	US
Telephone Number	:	385-201-7036
Fax Number	:

Provider Business Practice Location Address
First Line	:	10730 S LAKE RUN RD UNIT 3318
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-1872
Country	:	US
Telephone Number	:	385-201-7036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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