Healthcare Provider Details

I. General information

NPI: 1417532185
Provider Name (Legal Business Name): DAPHNE URSULA HARTZHEIM PH.D. CCC-SLP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 OLD MAIN HL
LOGAN UT
84322-5400
US

IV. Provider business mailing address

6410 OLD MAIN HL
LOGAN UT
84322-5400
US

V. Phone/Fax

Practice location:
  • Phone: 435-797-1375
  • Fax:
Mailing address:
  • Phone: 435-797-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6592345-4102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number6592345-2506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: