Healthcare Provider Details

I. General information

NPI: 1104393156
Provider Name (Legal Business Name): NORMAN DOUGLAS HUFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 E 700 S
SALEM UT
84653-9548
US

IV. Provider business mailing address

376 E 700 S
SALEM UT
84653-9548
US

V. Phone/Fax

Practice location:
  • Phone: 801-423-7836
  • Fax:
Mailing address:
  • Phone: 801-423-7836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number49776063501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: