Active NPI
Rena Eldredge, L.C.S.W.
- Clinical Social Worker
- Salt Lake City, UT
National Provider Identifier
1912160086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 343569-3501
- Practice address
- 925 E Executive Park Dr
Suite E
Salt Lake City, UT 84117-3581 - Phone
- (801) 904-2284
- NPI assigned
- Jul 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 343569-3502 | UT | |
| Clinical Social Worker | 1041C0700X | 343569-3501 | UT | Primary |
Addresses
Primary practice location
925 E Executive Park Dr
Suite E
Salt Lake City, UT 84117-3581
Mailing address
925 E Executive Park Dr
Suite E
Salt Lake City, UT 84117-3581
Phone (801) 904-2284
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 343569-3502 | UT | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Behavioral Health Incorporated | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- West Valley City, UT
- NPI 1932166980
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391644800000",
"number": "1912160086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "925 E EXECUTIVE PARK DR",
"address_2": "SUITE E",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841173581",
"telephone_number": "801-904-2284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 E EXECUTIVE PARK DR",
"address_2": "SUITE E",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841173581",
"telephone_number": "801-904-2284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELDREDGE",
"first_name": "RENA",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-08",
"last_updated": "2014-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "UT",
"license": "343569-3502",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "343569-3501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.