Healthcare Provider Details

I. General information

NPI: 1194440909
Provider Name (Legal Business Name): MRS. INGRID C NALDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 E TABERNACLE ST STE 200
ST GEORGE UT
84770-2968
US

IV. Provider business mailing address

1178 E 300 S APT C106
ST GEORGE UT
84790-2092
US

V. Phone/Fax

Practice location:
  • Phone: 435-229-8936
  • Fax:
Mailing address:
  • Phone: 435-229-8936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5588643-6018
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5588643-6010
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: