Provider Demographics
NPI:1386075752
Name:HENDRIKSEN, NATHAN (AUD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:HENDRIKSEN
Suffix:
Gender:M
Credentials:AUD
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 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-776-2180
Mailing Address - Fax:801-776-2534
Practice Address - Street 1:2255 N 1700 W STE 200
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1187
Practice Address - Country:US
Practice Address - Phone:801-776-2180
Practice Address - Fax:801-776-2534
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8705205-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1386075752Medicaid