Healthcare Provider Details

I. General information

NPI: 1912519349
Provider Name (Legal Business Name): ERIN BLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 W 300 N STE 4
HYDE PARK UT
84318-4044
US

IV. Provider business mailing address

835 W 720 N
TREMONTON UT
84337-2413
US

V. Phone/Fax

Practice location:
  • Phone: 435-227-5756
  • Fax:
Mailing address:
  • Phone: 435-512-5686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: