Healthcare Provider Details

I. General information

NPI: 1629982582
Provider Name (Legal Business Name): MOUNTAIN SAGE MIDWIFERY AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 N MAIN ST STE 11C
SUNSET UT
84015-2450
US

IV. Provider business mailing address

5829 S 2700 W
ROY UT
84067-1350
US

V. Phone/Fax

Practice location:
  • Phone: 801-368-8504
  • Fax:
Mailing address:
  • Phone: 801-368-8504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESSICA BARTLETT
Title or Position: OWNER/MIDWIFE
Credential: DNP, CNM, RN, IBCLC
Phone: 801-368-8504