Provider Demographics
NPI:1528705415
Name:VANDERMEIDE, GRACEN
Entity type:Individual
Prefix:
First Name:GRACEN
Middle Name:
Last Name:VANDERMEIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4947 S 3900 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-8635
Mailing Address - Country:US
Mailing Address - Phone:385-206-2618
Mailing Address - Fax:
Practice Address - Street 1:347 N 300 W STE 201A
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1828
Practice Address - Country:US
Practice Address - Phone:385-231-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker