Healthcare Provider Details

I. General information

NPI: 1831487420
Provider Name (Legal Business Name): ROY EVERETT HOGAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N 200 E APT 210
NORTH LOGAN UT
84341-3077
US

IV. Provider business mailing address

PO BOX 562
LOGAN UT
84323-0562
US

V. Phone/Fax

Practice location:
  • Phone: 385-247-1212
  • Fax: 385-466-4680
Mailing address:
  • Phone: 385-247-1212
  • Fax: 385-466-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60448962
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10640565-3501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-40573
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27620
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2021037248
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: