Provider Demographics
NPI:1124364013
Name:HAYDEN, WENDI LYN
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:LYN
Last Name:HAYDEN
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 1:4640 S 3500 W STE 4
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-6522
Mailing Address - Country:US
Mailing Address - Phone:801-603-4792
Mailing Address - Fax:
Practice Address - Street 1:4640 S 3500 W STE 4
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-6522
Practice Address - Country:US
Practice Address - Phone:801-603-4792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
9127605-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical