Healthcare Provider Details

I. General information

NPI: 1609704956
Provider Name (Legal Business Name): ELSIE MARIE SWIDERSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

25 ALPINE DR
PLEASANT GROVE UT
84062-3511
US

IV. Provider business mailing address

616 N INNOVATOR DR
FARMINGTON UT
84025-4462
US

V. Phone/Fax

Practice location:
  • Phone: 801-785-3568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14282147-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: