Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mark Tanner Fredrickson

Individual provider Clinical Social Worker · NPI 1265312094

Mark Tanner Fredrickson is a Clinical Social Worker in Salt Lake City, Utah. Licensed in Utah. Registered with an NPI since 2025.

Licensed in
UT
In the registry since
2025

Practice location Address checks out

1875 S Redwood Rd
Salt Lake City, UT 84104-5112
Phone: (801) 355-2846
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 14292963-3502 (UT)

Record details

NPI number1265312094
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 3, 2025
Last updated in NPPESJune 18, 2026
Certification dateJune 18, 2026

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