Healthcare Provider Details

I. General information

NPI: 1457278830
Provider Name (Legal Business Name): AMBER HACKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14551 SENTINEL RIDGE BLVD
HERRIMAN UT
84096
US

IV. Provider business mailing address

12495 S 1745 E
DRAPER UT
84020-6000
US

V. Phone/Fax

Practice location:
  • Phone: 801-458-1251
  • Fax:
Mailing address:
  • Phone: 801-458-1251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: