Healthcare Provider Details

I. General information

NPI: 1972435568
Provider Name (Legal Business Name): BREEZE HANNAFORD LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 S 1100 E
SLC UT
84105-2432
US

IV. Provider business mailing address

2072 E ATKIN AVE
SALT LAKE CITY UT
84109-1902
US

V. Phone/Fax

Practice location:
  • Phone: 801-948-2888
  • Fax: 801-948-2880
Mailing address:
  • Phone: 801-230-1724
  • Fax: 801-948-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BREEZE HANNAFORD-DYER
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 801-230-1724