Healthcare Provider Details

I. General information

NPI: 1306233358
Provider Name (Legal Business Name): LINDA JANE HOAGLAND ACMHC, SUDC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 GRANT AVE SUITE 107
OGDEN UT
84401-2308
US

IV. Provider business mailing address

PO BOX 1415
OGDEN UT
84402-1415
US

V. Phone/Fax

Practice location:
  • Phone: 801-388-2701
  • Fax:
Mailing address:
  • Phone: 801-388-2701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5734264-6006
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5734264-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: