Healthcare Provider Details

I. General information

NPI: 1134841711
Provider Name (Legal Business Name): SONATIX WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 E 1000 S STE A
PLEASANT GROVE UT
84062-3639
US

IV. Provider business mailing address

487 E 1000 S STE A
PLEASANT GROVE UT
84062-3639
US

V. Phone/Fax

Practice location:
  • Phone: 801-893-6399
  • Fax: 801-206-4175
Mailing address:
  • Phone: 801-893-6399
  • Fax: 801-206-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TENAE DANA
Title or Position: OFFICE MANAGER/BILLING
Credential:
Phone: 208-461-5716