1528335619 NPI number — TRUDY LARISSA SAMUELSON CMHC

Table of content: TRUDY LARISSA SAMUELSON CMHC (NPI 1528335619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528335619 NPI number — TRUDY LARISSA SAMUELSON CMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMUELSON
Provider First Name:
TRUDY
Provider Middle Name:
LARISSA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528335619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 E 4500 S STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84107-4502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-261-3500
Provider Business Mailing Address Fax Number:
385-500-3690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 E 4500 S STE 300
Provider Second Line Business Practice Location Address:
650 E 4500 S STE 300
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-8410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-261-3500
Provider Business Practice Location Address Fax Number:
385-500-3690
Provider Enumeration Date:
11/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  51392806004 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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