Healthcare Provider Details

I. General information

NPI: 1578451423
Provider Name (Legal Business Name): PATRICIA CARDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 PENNSYLVANIA AVE
OGDEN UT
84401-3320
US

IV. Provider business mailing address

1134 E 1000 N
OGDEN UT
84404-6658
US

V. Phone/Fax

Practice location:
  • Phone: 801-675-5624
  • Fax:
Mailing address:
  • Phone: 385-445-4553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number14211709-2702
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number14211709-2702
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: