Healthcare Provider Details

I. General information

NPI: 1316869654
Provider Name (Legal Business Name): MARIA ANDREA SALCEDO PSYD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 E 2100 S STE 102
SALT LAKE CITY UT
84105-3731
US

IV. Provider business mailing address

1371 E 2100 S STE 102
SALT LAKE CITY UT
84105-3731
US

V. Phone/Fax

Practice location:
  • Phone: 385-446-4964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number142401662501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: