Provider Demographics
NPI:1902102858
Name:MILNER, ANNETTE (SUDC, CMHC)
Entity type:Individual
Prefix:PROF
First Name:ANNETTE
Middle Name:
Last Name:MILNER
Suffix:
Gender:F
Credentials:SUDC, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 S HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1769
Mailing Address - Country:US
Mailing Address - Phone:801-759-1540
Mailing Address - Fax:801-906-8047
Practice Address - Street 1:2558 S 900 E STE B
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2239
Practice Address - Country:US
Practice Address - Phone:801-759-1540
Practice Address - Fax:801-906-8047
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6000064-6006101YA0400X
UT6000064-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)