Healthcare Provider Details

I. General information

NPI: 1366568925
Provider Name (Legal Business Name): RACHEL ANNE HENDRICKSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 S STATE ST STE A
MIDVALE UT
84047-6105
US

IV. Provider business mailing address

7321 S STATE ST STE A
MIDVALE UT
84047-6105
US

V. Phone/Fax

Practice location:
  • Phone: 801-878-4327
  • Fax:
Mailing address:
  • Phone: 801-878-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number64944403502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: