MEDICARE: DOUGLAS JAY HATCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	12278172-3502	UT
2	1041C0700X	Clinical Social Worker	12278172-3501	UT

General Provider Information

NPI Number	:	1083381156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS JAY HATCH

Provider Business Mailing Address
First Line	:	3494 S 3170 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-3142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3494 S 3170 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-3142
Country	:	US
Telephone Number	:	801-230-5405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	12/05/2024

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Directions to “ DOUGLAS JAY HATCH ” Practice Location

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