Healthcare Provider Details

I. General information

NPI: 1558265702
Provider Name (Legal Business Name): AIDEN DAVID MENDENHALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 E 3300 S
MILLCREEK UT
84106-3969
US

IV. Provider business mailing address

3543 E FIELDSTONE CIR
COTTONWOOD HEIGHTS UT
84121-5534
US

V. Phone/Fax

Practice location:
  • Phone: 385-533-8555
  • Fax:
Mailing address:
  • Phone: 385-608-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF26-170338
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: