Healthcare Provider Details

I. General information

NPI: 1457217200
Provider Name (Legal Business Name): ELDON BRENT HAMELIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 W 500 S
VERNAL UT
84078
US

IV. Provider business mailing address

1076 W 500 S
VERNAL UT
84078
US

V. Phone/Fax

Practice location:
  • Phone: 435-789-6300
  • Fax: 435-789-6357
Mailing address:
  • Phone: 435-789-6300
  • Fax: 435-789-6357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14239395-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: