Healthcare Provider Details

I. General information

NPI: 1922757848
Provider Name (Legal Business Name): STACY ACKERLIND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 S MAIN ST
SALT LAKE CITY UT
84115-5315
US

IV. Provider business mailing address

PO BOX 520554
SALT LAKE CITY UT
84152-0554
US

V. Phone/Fax

Practice location:
  • Phone: 801-981-5998
  • Fax:
Mailing address:
  • Phone: 801-556-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5559994-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: