Provider Demographics
NPI:1962386458
Name:LONGAKER, GRACE ANGELA
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANGELA
Last Name:LONGAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 S ASHLEY MESA LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-6115
Mailing Address - Country:US
Mailing Address - Phone:801-541-6731
Mailing Address - Fax:
Practice Address - Street 1:175 W 1400 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-6811
Practice Address - Country:US
Practice Address - Phone:435-752-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14237142-3503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker