Provider Demographics
NPI:1386898146
Name:EGBERT, ANDREA (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:EGBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3564 S 7200 W STE C
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-3507
Mailing Address - Country:US
Mailing Address - Phone:801-250-2909
Mailing Address - Fax:801-252-0444
Practice Address - Street 1:3564 S 7200 W STE C
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-3507
Practice Address - Country:US
Practice Address - Phone:801-250-2909
Practice Address - Fax:801-252-0444
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7061711-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical