Individual
MR. FREDERICK VAN DER VEUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1020 SOUTH MAIN STREET, 242, SALT LAKE CITY, UT 84101
(801) 539-7093
Mailing address
PO BOX 901173, SANDY, UT 84090-1173
(801) 580-3905
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1163593501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11635935003001
REGENCE BCBS
UT
01
—
1163593501
LSCW LICENSE #
UT
05
—
1780655407
—
UT
01
—
P00204131
RAILROAD MEDICARE
UT
Enumeration date
01/30/2006
Last updated
08/02/2012
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