Provider Demographics
NPI:1750695714
Name:MIDDLETON, INGRID MARIA (LCSW)
Entity type:Individual
Prefix:MISS
First Name:INGRID
Middle Name:MARIA
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2330
Mailing Address - Country:US
Mailing Address - Phone:808-358-7363
Mailing Address - Fax:
Practice Address - Street 1:950 E LOGAN AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2330
Practice Address - Country:US
Practice Address - Phone:808-358-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI36361041C0700X
VA09040101551041C0700X
CA775191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical