Provider Demographics
NPI:1588709729
Name:ANDERSON, CARRIE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ANN
Last Name:ANDERSON
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 1:262 E 3900 S STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2465
Mailing Address - Country:US
Mailing Address - Phone:385-257-3317
Mailing Address - Fax:
Practice Address - Street 1:262 E 3900 S STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2465
Practice Address - Country:US
Practice Address - Phone:385-257-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006313A1041C0700X
IL1490118621041C0700X
UT10708379-35011041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical