Healthcare Provider Details

I. General information

NPI: 1508496605
Provider Name (Legal Business Name): MISTIE JOLENE HOAGLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 HERITAGE PARK BLVD
LAYTON UT
84041-5711
US

IV. Provider business mailing address

320 W 4950 S APT A
OGDEN UT
84405-6321
US

V. Phone/Fax

Practice location:
  • Phone: 801-525-9998
  • Fax: 801-525-6984
Mailing address:
  • Phone: 801-695-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: