Healthcare Provider Details

I. General information

NPI: 1063741429
Provider Name (Legal Business Name): RICKY D. HAWKS ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5677 S 1475 E SUITE 4A
OGDEN UT
84403-7032
US

IV. Provider business mailing address

2730 N 850 E
NORTH OGDEN UT
84414-2414
US

V. Phone/Fax

Practice location:
  • Phone: 801-621-6032
  • Fax: 801-409-0905
Mailing address:
  • Phone: 801-782-3551
  • Fax: 801-782-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number115258-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: