Healthcare Provider Details

I. General information

NPI: 1407239437
Provider Name (Legal Business Name): SCOTT HULL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 W 300 S
LOGAN UT
84321-5245
US

IV. Provider business mailing address

PO BOX 489
MILLVILLE UT
84326-0489
US

V. Phone/Fax

Practice location:
  • Phone: 435-999-4313
  • Fax:
Mailing address:
  • Phone: 435-999-4313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5484293-3501
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: