Healthcare Provider Details

I. General information

NPI: 1023758992
Provider Name (Legal Business Name): MADISON MICHELLE HATCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 S 800 E
OREM UT
84097-7275
US

IV. Provider business mailing address

789 E 450 S
SANTAQUIN UT
84655-8007
US

V. Phone/Fax

Practice location:
  • Phone: 801-318-4653
  • Fax:
Mailing address:
  • Phone: 801-318-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: