Provider Demographics
NPI:1194440909
Name:NALDER, INGRID C
Entity type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:C
Last Name:NALDER
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 1:1178 E 300 S APT C106
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2092
Mailing Address - Country:US
Mailing Address - Phone:435-229-8936
Mailing Address - Fax:
Practice Address - Street 1:249 E TABERNACLE ST STE 200
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2968
Practice Address - Country:US
Practice Address - Phone:435-229-8936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5588643-6010101YM0800X
UT5588643-6018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT013314696OtherDRIVERS LICENSE