Provider Demographics
NPI:1326436478
Name:LAVENBERG, ANNA KENDALL
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KENDALL
Last Name:LAVENBERG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 W 9000 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5729
Mailing Address - Country:US
Mailing Address - Phone:802-881-9778
Mailing Address - Fax:
Practice Address - Street 1:986 W 9000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5729
Practice Address - Country:US
Practice Address - Phone:802-881-9778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst