Healthcare Provider Details

I. General information

NPI: 1144559857
Provider Name (Legal Business Name): KENNETH LYNN HULL L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 W FOX HOLLOW DR
NORTH SALT LAKE UT
84054-6008
US

IV. Provider business mailing address

PO BOX 540724
NORTH SALT LAKE UT
84054-0724
US

V. Phone/Fax

Practice location:
  • Phone: 801-891-0400
  • Fax: 801-298-0846
Mailing address:
  • Phone: 801-891-0400
  • Fax: 801-298-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5021920-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: