Healthcare Provider Details

I. General information

NPI: 1659295293
Provider Name (Legal Business Name): MRS. LEILA ERIKA MORTENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E 9000 S
SANDY UT
84070-2201
US

IV. Provider business mailing address

4843 W MOUNTAIN HILL DR
WEST JORDAN UT
84081-3981
US

V. Phone/Fax

Practice location:
  • Phone: 385-775-4019
  • Fax:
Mailing address:
  • Phone: 801-755-6896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14191381-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: