Healthcare Provider Details

I. General information

NPI: 1164385381
Provider Name (Legal Business Name): LACEY HILL BUCHANAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 N 400 E
LOGAN UT
84341-2321
US

IV. Provider business mailing address

609 W 160 N
SMITHFIELD UT
84335-6605
US

V. Phone/Fax

Practice location:
  • Phone: 801-871-5118
  • Fax:
Mailing address:
  • Phone: 435-232-3398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7009530-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: