Healthcare Provider Details

I. General information

NPI: 1548015209
Provider Name (Legal Business Name): ZACKARY L WARD BHCM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S MAIN ST
TOOELE UT
84074-2163
US

IV. Provider business mailing address

60 S MAIN ST
TOOELE UT
84074-2163
US

V. Phone/Fax

Practice location:
  • Phone: 801-648-5351
  • Fax:
Mailing address:
  • Phone: 801-648-5351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF24-112038
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberF24-115993
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: