Provider Demographics
NPI:1013414408
Name:SAUCEDO, ELISABETH CONSTANCE
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:CONSTANCE
Last Name:SAUCEDO
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 1:4655 S 1900 W STE 5
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-2773
Mailing Address - Country:US
Mailing Address - Phone:385-456-5778
Mailing Address - Fax:801-797-0252
Practice Address - Street 1:4655 S 1900 W
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-2772
Practice Address - Country:US
Practice Address - Phone:385-456-5778
Practice Address - Fax:801-797-0252
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9753119-35011041C0700X
1041C0700X, 101Y00000X
UT101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055266OtherMEDICARE PIN
UT260022408OtherRAILROAD MEDICARE
UT260022408OtherRAILROAD MEDICARE