Healthcare Provider Details

I. General information

NPI: 1265404032
Provider Name (Legal Business Name): KENNETH JOHN HOPPS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 E 3900 S SUITE A-170
SALT LAKE CITY UT
84124-1215
US

IV. Provider business mailing address

4487 ARCADIA LN
HOLLADAY UT
84124-3507
US

V. Phone/Fax

Practice location:
  • Phone: 801-270-6534
  • Fax: 801-284-4991
Mailing address:
  • Phone: 801-277-7099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number117202501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: