Provider Demographics
NPI:1558798553
Name:FJELDSTED, PATRICIA H
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:H
Last Name:FJELDSTED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W 1400 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6811
Mailing Address - Country:US
Mailing Address - Phone:435-752-5302
Mailing Address - Fax:
Practice Address - Street 1:175 W 1400 N
Practice Address - Street 2:SUITE A
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-6811
Practice Address - Country:US
Practice Address - Phone:435-752-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9068996-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical