Provider Demographics
NPI:1144081878
Name:DURASIN, MEGAN (CSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:DURASIN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:DURASIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSW
Mailing Address - Street 1:117 W 400 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1916
Mailing Address - Country:US
Mailing Address - Phone:801-428-4257
Mailing Address - Fax:
Practice Address - Street 1:117 W 400 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1916
Practice Address - Country:US
Practice Address - Phone:801-428-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11655467-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8760003008007Medicaid
UT000055266OtherMEDICARE PIN
UT260022408OtherRAILROAD MEDICARE