Healthcare Provider Details

I. General information

NPI: 1083534457
Provider Name (Legal Business Name): MIRANDA HAINSWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 S 1100 E
SALT LAKE CITY UT
84105-2441
US

IV. Provider business mailing address

1570 S 1100 E
SALT LAKE CITY UT
84105-2441
US

V. Phone/Fax

Practice location:
  • Phone: 385-202-4089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14093308-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: