Healthcare Provider Details

I. General information

NPI: 1477462299
Provider Name (Legal Business Name): SUSAN WHIRLWIND-SOLDIER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5541 W WILDBERRY CIR
KEARNS UT
84118-8563
US

IV. Provider business mailing address

5541 W WILDBERRY CIR
KEARNS UT
84118-8563
US

V. Phone/Fax

Practice location:
  • Phone: 385-619-2256
  • Fax:
Mailing address:
  • Phone: 385-619-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: