MEDICARE: BREEZE HANNAFORD LCSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1972435568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREEZE HANNAFORD LCSW PLLC

Provider Business Mailing Address
First Line	:	2072 E ATKIN AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1902
Country	:	US
Telephone Number	:	801-230-1724
Fax Number	:	801-948-2880

Provider Business Practice Location Address
First Line	:	1343 S 1100 E
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84105-2432
Country	:	US
Telephone Number	:	801-948-2888
Fax Number	:	801-948-2880

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	BREEZE HANNAFORD-DYER
Credential	:	LCSW
Telephone Number	:	801-230-1724

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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