Healthcare Provider Details

I. General information

NPI: 1760788491
Provider Name (Legal Business Name): HEATHER D POTOKAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 S STATE ST STE 230
CLEARFIELD UT
84015-1001
US

IV. Provider business mailing address

189 S STATE ST STE 230
CLEARFIELD UT
84015-1001
US

V. Phone/Fax

Practice location:
  • Phone: 801-589-0819
  • Fax: 866-722-2081
Mailing address:
  • Phone: 801-589-0819
  • Fax: 667-222-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30832403501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: