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NPI Code Detail

MEDICARE: SUSAN CAROL HOFFMAN

MEDICARE: SUSAN CAROL HOFFMAN
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
11041C0700XClinical Social Worker264474-3501UT

General Provider Information

NPI Number : 1093096026
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN CAROL HOFFMAN
Provider Business Mailing Address
First Line : 1531 OLD SHEPARD RD
Second Line :
City : FARMINGTON
State : UT
Zip : 84025-2846
Country : US
Telephone Number : 801-819-4480
Fax Number :
Provider Business Practice Location Address
First Line : 4943 WASATCH BLVD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-4798
Country : US
Telephone Number : 801-449-0089
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2011
Last Update Date : 05/14/2014

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