Healthcare Provider Details

I. General information

NPI: 1386072551
Provider Name (Legal Business Name): ADA MARIE HENINGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 E 4750 S
OGDEN UT
84403-4235
US

IV. Provider business mailing address

685 E 4750 S
OGDEN UT
84403-4235
US

V. Phone/Fax

Practice location:
  • Phone: 385-350-0933
  • Fax:
Mailing address:
  • Phone: 385-350-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number334867-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: