Provider Demographics
NPI:1285330746
Name:SANDERS, MEGAN COLLEEN (CSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:COLLEEN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10675 S 700 E APT 5
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4915
Mailing Address - Country:US
Mailing Address - Phone:435-559-9035
Mailing Address - Fax:
Practice Address - Street 1:1050 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2184
Practice Address - Country:US
Practice Address - Phone:801-645-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11663737-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT104100000XMedicaid