Healthcare Provider Details

I. General information

NPI: 1437816931
Provider Name (Legal Business Name): SUZANNE HALES GIBB LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 24TH ST STE 1A
OGDEN UT
84401-2580
US

IV. Provider business mailing address

707 24TH ST STE 1A
OGDEN UT
84401-2580
US

V. Phone/Fax

Practice location:
  • Phone: 385-348-1473
  • Fax:
Mailing address:
  • Phone: 385-348-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number134344253501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: