Healthcare Provider Details

I. General information

NPI: 1255630018
Provider Name (Legal Business Name): BONNIE HATCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2011
Last Update Date: 03/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 W CENTER ST
OREM UT
84057-5201
US

IV. Provider business mailing address

633 W 250 N
LINDON UT
84042-1344
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-9222
  • Fax:
Mailing address:
  • Phone: 801-885-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5738583-3501
License Number StateUT

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: