Mark Tanner Fredrickson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14292963-3502 Issued in UT

Practice address

1875 S Redwood Rd
Salt Lake City, UT 84104-5112

Phone

(801) 355-2846

NPI assigned

Sep 3, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1756857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781740800000",
    "number": "1265312094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 S REDWOOD RD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841045112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 S REDWOOD RD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841045112",
            "telephone_number": "801-355-2846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICKSON",
        "first_name": "MARK",
        "middle_name": "TANNER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-09-03",
        "last_updated": "2026-06-18",
        "certification_date": "2026-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "14292963-3502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Irene Fredbo, PA-C
• Madison Hope Frederick
• Marc K Frederick
• Raelynn Frederickson, RN
• Kristin Krogue Fredrickson
• Bradley Free
• Gregory Lee Freebairn, DC
• Karen Lynn Freed, MD, MPH
• Sasha Gabrielle Freed, LCSW
• Elizabeth May Freedman

• Clinical Social Worker in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.