Healthcare Provider Details

I. General information

NPI: 1285323881
Provider Name (Legal Business Name): REAGAN AMMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date: 09/25/2026
Reactivation Date: 09/29/2026

III. Provider practice location address

7070 S UNION PARK AVE STE 150
MIDVALE UT
84047-6043
US

IV. Provider business mailing address

PO BOX 171123
HOLLADAY UT
84117-1123
US

V. Phone/Fax

Practice location:
  • Phone: 801-405-7450
  • Fax: 385-446-2650
Mailing address:
  • Phone: 801-405-7450
  • Fax: 385-446-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14307205-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: