Healthcare Provider Details

I. General information

NPI: 1386577393
Provider Name (Legal Business Name): IVONETTE LINDY HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 HARRISON BLVD
OGDEN UT
84401-0717
US

IV. Provider business mailing address

1945 HARRISON BLVD
OGDEN UT
84401-0717
US

V. Phone/Fax

Practice location:
  • Phone: 801-430-4288
  • Fax: 801-430-4288
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number229555370
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: