Healthcare Provider Details

I. General information

NPI: 1043175946
Provider Name (Legal Business Name): MINDI HADDOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 W 1150 N
WEST POINT UT
84015-7570
US

IV. Provider business mailing address

3125 W 1150 N
WEST POINT UT
84015-7570
US

V. Phone/Fax

Practice location:
  • Phone: 801-698-9632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8773079-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: