Healthcare Provider Details

I. General information

NPI: 1417537598
Provider Name (Legal Business Name): LUCY ANN FALK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCY ANN GOCHNOUR

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2046 E MURRAY HOLLADAY RD STE 101
HOLLADAY UT
84117-5173
US

IV. Provider business mailing address

556 E 300 S STE 108
AMERICAN FORK UT
84003-3844
US

V. Phone/Fax

Practice location:
  • Phone: 801-980-2566
  • Fax:
Mailing address:
  • Phone: 801-980-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12267018-3502
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: