Healthcare Provider Details

I. General information

NPI: 1316841786
Provider Name (Legal Business Name): MACKENZIE CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E COTTONWOOD PKWY STE 500
SALT LAKE CITY UT
84121-7060
US

IV. Provider business mailing address

433 W ROLLING SAGE WAY
SARATOGA SPRINGS UT
84045-5372
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-3677
  • Fax:
Mailing address:
  • Phone: 208-860-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: