Healthcare Provider Details

I. General information

NPI: 1689343154
Provider Name (Legal Business Name): MALINDA M CALDWELL BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 01/02/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 E FRANKLIN DR
EAGLE MOUNTAIN UT
84005-5839
US

IV. Provider business mailing address

750 N FREEDOM BLVD STE 300
PROVO UT
84601-1690
US

V. Phone/Fax

Practice location:
  • Phone: 208-227-3743
  • Fax:
Mailing address:
  • Phone: 801-852-4714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: