MEDICARE: HANNAH BAMBROUGH

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	12328680-3501	UT

General Provider Information

NPI Number	:	1568015410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH BAMBROUGH

Provider Business Mailing Address
First Line	:	725 E SUNSET PONDS DR
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-8509
Country	:	US
Telephone Number	:	385-202-3654
Fax Number	:

Provider Business Practice Location Address
First Line	:	9135 S MONROE PLAZA WAY STE C
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-2692
Country	:	US
Telephone Number	:	385-202-3654
Fax Number	:

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

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	12/15/2025

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Directions to “ HANNAH BAMBROUGH ” Practice Location

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