Healthcare Provider Details

I. General information

NPI: 1811198211
Provider Name (Legal Business Name): HANNAH LARUE MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 N 1000 W
TREMONTON UT
84337-9356
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-207-4800
  • Fax: 435-207-4808
Mailing address:
  • Phone: 435-207-4800
  • Fax: 435-207-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5909371-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: