MEDICARE: BLANCA V BUCHANAN LSUDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	10874260-6006	UT

General Provider Information

NPI Number	:	1750239570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLANCA V BUCHANAN LSUDC

Provider Business Mailing Address
First Line	:	7050 S UNION PARK AVE STE 200
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-4171
Country	:	US
Telephone Number	:	888-483-0760
Fax Number	:

Provider Business Practice Location Address
First Line	:	7050 S UNION PARK AVE STE 200
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-4171
Country	:	US
Telephone Number	:	888-483-0760
Fax Number	:

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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