Healthcare Provider Details

I. General information

NPI: 1295951564
Provider Name (Legal Business Name): AMY J HOPKINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3856 S 3600 W
WEST HAVEN UT
84401-6833
US

IV. Provider business mailing address

3856 S 3600 W
WEST HAVEN UT
84401-6833
US

V. Phone/Fax

Practice location:
  • Phone: 801-690-6520
  • Fax:
Mailing address:
  • Phone: 801-690-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number367983-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: