Healthcare Provider Details

I. General information

NPI: 1477457349
Provider Name (Legal Business Name): MADLINE WENDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE HAWKINS

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 4500 S STE 220
MURRAY UT
84107-4520
US

IV. Provider business mailing address

650 E 4500 S STE 220
MURRAY UT
84107-4520
US

V. Phone/Fax

Practice location:
  • Phone: 801-363-4596
  • Fax:
Mailing address:
  • Phone: 801-363-4596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14306227-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: