Healthcare Provider Details

I. General information

NPI: 1134060981
Provider Name (Legal Business Name): TESSA C HUECKSTEADT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 S REDWOOD RD
SALT LAKE CITY UT
84104-5112
US

IV. Provider business mailing address

6491 E EMIGRATION CANYON RD
SALT LAKE CITY UT
84108-1786
US

V. Phone/Fax

Practice location:
  • Phone: 801-355-2846
  • Fax: 801-359-3244
Mailing address:
  • Phone: 801-635-0689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: