Healthcare Provider Details

I. General information

NPI: 1770878019
Provider Name (Legal Business Name): KATIE HENDRICKSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N 1420 E
OREM UT
84097-5484
US

IV. Provider business mailing address

PO BOX 971534
OREM UT
84097-1534
US

V. Phone/Fax

Practice location:
  • Phone: 435-668-5773
  • Fax:
Mailing address:
  • Phone: 435-668-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10376863-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: