Provider Demographics
NPI:1093096026
Name:HOFFMAN, SUSAN CAROL
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JOHANSEN
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1531 OLD SHEPARD RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2846
Mailing Address - Country:US
Mailing Address - Phone:801-819-4480
Mailing Address - Fax:
Practice Address - Street 1:4943 WASATCH BLVD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-4798
Practice Address - Country:US
Practice Address - Phone:801-449-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-04
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT264474-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical