Healthcare Provider Details

I. General information

NPI: 1457751810
Provider Name (Legal Business Name): HEATHER CHRISTIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 S DIXIE DR STE E102
ST GEORGE UT
84770-7329
US

IV. Provider business mailing address

1664 S DIXIE DR STE E102
ST GEORGE UT
84770-7329
US

V. Phone/Fax

Practice location:
  • Phone: 435-703-9647
  • Fax:
Mailing address:
  • Phone: 435-703-9647
  • Fax: 435-703-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9410787-3501
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier1295852981
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: