Healthcare Provider Details

I. General information

NPI: 1326969866
Provider Name (Legal Business Name): MATILDA YELLOWHORSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 N AARON DR STE I
TOOELE UT
84074-8112
US

IV. Provider business mailing address

975 E 400 S APT 3
SALT LAKE CITY UT
84102-3076
US

V. Phone/Fax

Practice location:
  • Phone: 435-241-1023
  • Fax:
Mailing address:
  • Phone: 435-241-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11793612-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: