Healthcare Provider Details

I. General information

NPI: 1760308035
Provider Name (Legal Business Name): AVA HENDRICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 S STATE ST
CLEARFIELD UT
84015-1600
US

IV. Provider business mailing address

4056 S 875 E
OGDEN UT
84403-2412
US

V. Phone/Fax

Practice location:
  • Phone: 385-390-0027
  • Fax:
Mailing address:
  • Phone: 385-515-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: