MS. MAXINE E MICKELSEN (NPI# 1316288582) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316288582 |
| Entity Type | Individual |
| Full Name | MS. MAXINE E MICKELSEN |
| Practice Address |
252 S 500 E Salt Lake City UT 84102-2030 |
| Practice Telephone | 8012367710 |
| Mailing Telephone | 8012367710 |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2013-03-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 167G00000X | Licensed Psychiatric Technician | Nursing Service Providers |
| Street Address |
252 S 500 E |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84102-2030 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326020512 | Mabel Ann Jentzsch | Social Worker | 252 S 500 E, Salt Lake City, UT 84102-2030 | 2005-11-15 |
| 1023410321 | Briggs Alsbury | Social Worker | 252 S 500 E, Salt Lake City, UT 84102-2030 | 2014-09-18 |
| 1659783686 | Jessica Tenney | Registered Nurse | 252 S 500 E, Salt Lake City, UT 84102-2030 | 2014-05-26 |
| 1336565597 | Caitlin Ehrich | Case Manager/Care Coordinator | 252 S 500 E, Salt Lake City, UT 84102-2030 | 2014-03-12 |
| 1609207729 | Nathan Erickson | Registered Nurse | 252 S 500 E, Salt Lake City, UT 84102-2030 | 2013-11-30 |
| 1962839415 | Joshua Bryan Dowdle | Social Worker | 252 S 500 E, Salt Lake City, UT 84102-2030 | 2013-09-30 |
| 1548695349 | Ashlee Roberts Gudmundson | Nurse's Aide | 252 S 500 E, Salt Lake City, UT 84102-2030 | 2013-09-11 |
| 1578905634 | Marci Park | Registered Nurse | 252 S 500 E, Salt Lake City, UT 84102-2030 | 2013-07-17 |
| 1811337173 | Amanda Duncan | Specialist | 252 S 500 E, Salt Lake City, UT 84102-2030 | 2013-07-01 |
| 1316288590 | Bradley Maynard | Counselor | 252 S 500 E, Salt Lake City, UT 84102-2030 | 2013-03-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942818604 | Wendy Vazquez | Behavior Technician | 515 S 700 E Suit 2a, Salt Lake City, UT 84102 | 2020-07-20 |
| 1407481245 | Odyssey House Inc | Family Medicine | 743 E 300 S, Salt Lake City, UT 84102 | 2020-03-11 |
| 1093359960 | Hayle Mayer | Behavior Technician | 515 S 700 E Salt Lake City, Suite 2a, Salt Lake, UT 84102 | 2019-11-04 |
| 1326680869 | Ronald Mcdonald House of The Intermountain Area | Meals | 935 E. South Temple, Salt Lake City, UT 84102 | 2019-10-16 |
| 1508419581 | Claire Pemberton | Behavior Technician | 327 E 1300 S, Apt 2, Salt Lake City, UT 84102 | 2019-07-19 |
| 1558923144 | Olivia Anne Hardwick | Social Worker | Transitions At Slrmc, 86 S. 1100 E. Suite 404, Salt Lake City, UT 84102 | 2019-07-03 |
| 1649741802 | Colten Vancampen | Behavior Technician | 515 S 700 E #2a, Salt Lake City, UT 84102 | 2018-12-16 |
| 1457847964 | Utah Podiatry Group PC | Podiatrist | 24 S 1100 E Ste 120, Salt Lake City, UT 84102 | 2018-07-09 |
| 1104311661 | Malorey Kooyman | Behavior Technician | 515 700 East, Suite 2a, Salt Lake City, UT 84102 | 2018-06-27 |
| 1700384930 | Utah Podiatry Group PC | Podiatrist | 82 S 1100 E Ste 301, Salt Lake City, UT 84102 | 2018-01-23 |
| Find all providers in zip 84102 | ||||
| Taxonomy Code | 167G00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Psychiatric Technician |
| An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245584952 | Nicholas Shifrar | Licensed Psychiatric Technician | 620 S 1300 E, Salt Lake City, UT 84102-3207 | 2012-11-02 |
| 1104172048 | Thomas Pruitt | Licensed Psychiatric Technician | 501 E Chipeta Way, Salt Lake City, UT 84108-1222 | 2012-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548716236 | Andres Ramos | Licensed Psychiatric Technician | 697 West 4170 South, Murray, UT 84123 | 2016-09-01 |
| 1932632460 | Adelle Price | Licensed Psychiatric Technician | 697 W 4170 S, Murray, UT 84123-1326 | 2017-04-11 |
| 1356796825 | Lisa Dawn Eastman | Licensed Psychiatric Technician | 697 W 4170 S, Murray, UT 84123-1326 | 2016-05-03 |
| 1689058117 | Kristen Courtney | Licensed Psychiatric Technician | 697 W 4170 S, Murray, UT 84123-1326 | 2015-07-14 |
| City | SALT LAKE CITY |
| Zip Code | 84102 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.