MEDICARE: MS. AMELIA HOPKIN 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	101YP2500X	Professional Counselor	5963868-3501	UT

General Provider Information

NPI Number	:	1962976738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMELIA HOPKIN LCSW

Provider Business Mailing Address
First Line	:	582 E 4400 S
Second Line	:
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-3839
Country	:	US
Telephone Number	:	801-231-1837
Fax Number	:

Provider Business Practice Location Address
First Line	:	3785 HARRISON BLVD STE 4
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-2072
Country	:	US
Telephone Number	:	801-231-1837
Fax Number	:

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

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	01/15/2019

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