Healthcare Provider Details

I. General information

NPI: 1225958895
Provider Name (Legal Business Name): LISA HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 N MAIN ST STE 220
LAYTON UT
84041-4886
US

IV. Provider business mailing address

996 S SUNCREST CIR
KAYSVILLE UT
84037-9434
US

V. Phone/Fax

Practice location:
  • Phone: 801-928-1493
  • Fax:
Mailing address:
  • Phone: 801-928-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: