Provider Demographics
NPI:1134975543
Name:MATTINSON, KADEN CHAD (EMT, FPSS, QPR INSTR)
Entity type:Individual
Prefix:
First Name:KADEN
Middle Name:CHAD
Last Name:MATTINSON
Suffix:
Gender:M
Credentials:EMT, FPSS, QPR INSTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-0310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:639 SWENSON AVE APT 1
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2560
Practice Address - Country:US
Practice Address - Phone:801-259-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2023038607146N00000X
172A00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No172A00000XOther Service ProvidersDriver