MEDICARE: ANNIE HAMILTON LCSW

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	10539017-3501	UT

General Provider Information

NPI Number	:	1316731425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE HAMILTON LCSW

Provider Business Mailing Address
First Line	:	184 E SILVER WILLOW DR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-4227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 S 1700 E
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84108-2273
Country	:	US
Telephone Number	:	385-246-2971
Fax Number	:

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

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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