Individual
CORNELIUS ISAAC VAN ROOSENDAAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1161 E 300 N, PROVO, UT 84606-3539
(801) 373-4760
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
14267276-3503
UT
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/04/2022
Last updated
02/11/2026
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