Individual
ETHAN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1157 E 300 N, PROVO, UT 84606-3539
(801) 852-2131
Mailing address
750 N FREEDOM BLVD STE 300, PROVO, UT 84601-1690
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/30/2025
Last updated
09/30/2025
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