Healthcare Provider Details

I. General information

NPI: 1134051808
Provider Name (Legal Business Name): HANNAH HEISELBETZ CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH COLEMAN

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 E 1960 S
OREM UT
84058-8136
US

IV. Provider business mailing address

444 E 1960 S
OREM UT
84058-8136
US

V. Phone/Fax

Practice location:
  • Phone: 801-917-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14287240-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: