Individual
DR. KENT W ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
545 W 465 N, SUITE 130, PROVIDENCE, UT 84332-8003
(435) 752-7627
(435) 752-7802
Mailing address
545 W 465 N, SUITE 130, PROVIDENCE, UT 84332-8003
(435) 752-7627
(435) 752-7802
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
324469-2501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107007866101
IHC
UT
01
—
292486
DMBA
UT
01
—
52082
PEHP
UT
01
—
870621775
TAX IDENTIFICATION #
UT
01
—
870621775AN2
EDUCATORS MUTUAL INSURANC
UT
Enumeration date
03/12/2007
Last updated
01/26/2010
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