Agency Information

BLACKHAWK INSURANCE

Address:

1756 E 700 S

SPRINGVILLE, UT 84663

Phone

801-358-8558

URL:

Email:

mortensen1998@msn.com

National Producer Number:

16195748

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res. Producer Firm	3550509	06/17/2020	Active	06/17/2020	06/30/2026

Qualification Type	Original Issue Date	Status	Effective Date
Health	06/17/2020	Active	06/17/2020
Life	06/17/2020	Active	06/17/2020

Company Name	Appointment Type	Status	Active Date
106276
AETNA HEALTH INC (PA)	Health	Active	10/28/2023
17687
Company Name	Appointment Type	Status	Active Date
MOLINA HEALTHCARE OF NEVADA INC	Health	Active	07/14/2022

row(s) 1 - 2 of 2

Name	Association Type	Agent	Begin Date	End Date
MATTHEW WILLIAM MORTENSEN	Designated Resp Lic Prdcr	Yes	06/17/2020	-

1 - 1