MEDICARE: SUSAN DEE HODGES

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	1041C0700X	Clinical Social Worker	4816499-3501	UT

General Provider Information

NPI Number	:	1104333673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DEE HODGES

Provider Business Mailing Address
First Line	:	4640 S 3500 W STE 4
Second Line	:
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-6522
Country	:	US
Telephone Number	:	801-603-4792
Fax Number	:

Provider Business Practice Location Address
First Line	:	4640 S 3500 W STE 4
Second Line	:
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-6522
Country	:	US
Telephone Number	:	801-603-4792
Fax Number	:

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

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	01/15/2026

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Directions to “ SUSAN DEE HODGES ” Practice Location

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