Healthcare Provider Details

I. General information

NPI: 1154250223
Provider Name (Legal Business Name): HEIDI CANALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 E COBBLESTONE LN
MIDVALE UT
84047-4611
US

IV. Provider business mailing address

664 E COBBLESTONE LN
MIDVALE UT
84047-4611
US

V. Phone/Fax

Practice location:
  • Phone: 801-596-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14239699-6006
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: