Healthcare Provider Details

I. General information

NPI: 1407125701
Provider Name (Legal Business Name): CASSANDRA HUTCHINSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S STATE ST
SOUTH SALT LAKE UT
84115-3164
US

IV. Provider business mailing address

PO BOX 2603 HTN, CLIENT ACCOUNTING
FORT WORTH TX
76113-2603
US

V. Phone/Fax

Practice location:
  • Phone: 385-646-0793
  • Fax:
Mailing address:
  • Phone: 817-569-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4972893
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: