Healthcare Provider Details

I. General information

NPI: 1720806474
Provider Name (Legal Business Name): TRADEMARK THERAPY A PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 S 1300 E STE 500
SALT LAKE CITY UT
84106-4375
US

IV. Provider business mailing address

665 E WILSON AVE
SALT LAKE CITY UT
84105-3007
US

V. Phone/Fax

Practice location:
  • Phone: 801-609-4524
  • Fax:
Mailing address:
  • Phone: 801-580-5689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: REBECCA ANN SIGNE ABLAD
Title or Position: OWNER
Credential: LCSW
Phone: 801-580-5689