Provider Demographics
NPI:1003973611
Name:HOGARTY BAKER, NANCY M (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:HOGARTY BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:M
Other - Last Name:HOGARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5250 SO COMMERCE DR
Mailing Address - Street 2:STE 250
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-261-3500
Mailing Address - Fax:801-261-2111
Practice Address - Street 1:5250 SO COMMERCE DR
Practice Address - Street 2:STE 250
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-261-3500
Practice Address - Fax:801-261-2111
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12310535011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical