Provider Demographics
NPI:1245115328
Name:VANDER VEUR, ETHAN
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:VANDER VEUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11896 S WOODRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5709
Mailing Address - Country:US
Mailing Address - Phone:801-815-9372
Mailing Address - Fax:
Practice Address - Street 1:11978 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7403
Practice Address - Country:US
Practice Address - Phone:801-923-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)