Provider Demographics
NPI:1790207561
Name:TRAEDEN, HEATHER MARCIE (MED)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARCIE
Last Name:TRAEDEN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 E 300 S
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2258
Mailing Address - Country:US
Mailing Address - Phone:801-897-5604
Mailing Address - Fax:801-992-8058
Practice Address - Street 1:283 E 300 S
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2258
Practice Address - Country:US
Practice Address - Phone:801-897-5604
Practice Address - Fax:801-992-8058
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1-20-41985103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst