Healthcare Provider Details

I. General information

NPI: 1013414408
Provider Name (Legal Business Name): ELISABETH CONSTANCE SAUCEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 S 1900 W
ROY UT
84067-2772
US

IV. Provider business mailing address

4655 S 1900 W STE 5
ROY UT
84067-2773
US

V. Phone/Fax

Practice location:
  • Phone: 385-456-5778
  • Fax: 801-797-0252
Mailing address:
  • Phone: 385-456-5778
  • Fax: 801-797-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9753119-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier000055266
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerMEDICARE PIN
# 2
Identifier260022408
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: