Healthcare Provider Details

I. General information

NPI: 1407557325
Provider Name (Legal Business Name): KAITLIN MORTENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7533 S CENTER VIEW CT # 5150
WEST JORDAN UT
84084-5526
US

IV. Provider business mailing address

7533 S CENTER VIEW CT # 5150
WEST JORDAN UT
84084-5526
US

V. Phone/Fax

Practice location:
  • Phone: 801-214-8070
  • Fax:
Mailing address:
  • Phone: 801-214-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14256638-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: