Healthcare Provider Details

I. General information

NPI: 1043625783
Provider Name (Legal Business Name): JOHN M OGDEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 W BAGLEY PARK RD
WEST JORDAN UT
84081-5697
US

IV. Provider business mailing address

5500 W BAGLEY PARK RD
WEST JORDAN UT
84081-5697
US

V. Phone/Fax

Practice location:
  • Phone: 801-282-1000
  • Fax: 801-282-1198
Mailing address:
  • Phone: 801-282-1000
  • Fax: 801-282-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number57247683501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: