Mandy Donavan, LCSW
Individual provider Active NPI Clinical Social Worker · Logan, UT
NPI 1356838486 · NPPES record last updated Apr 14, 2018
Key facts
- NPI
- 1356838486
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 69837453501 (UT)
- Practice address
- 258 S Main St
Logan, UT 84321-5767 - Phone
- (435) 512-9492
- NPI assigned
- Apr 14, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 69837453501 | UT | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 69837453501 | UT | Yes |
Addresses
Primary practice location
258 S Main St
Logan, UT 84321-5767
Mailing address
1248 Grandview Dr
Providence, UT 84332-9317
Phone (435) 512-9492
Other providers in Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.