Provider Demographics
NPI:1053003582
Name:ANDERSEN, STEVEN JOHN (LCSW)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOHN
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 E 1810 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-7363
Mailing Address - Country:US
Mailing Address - Phone:801-636-2100
Mailing Address - Fax:
Practice Address - Street 1:856 E 1810 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7363
Practice Address - Country:US
Practice Address - Phone:801-636-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT137622-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical