Provider Demographics
NPI:1417532185
Name:HARTZHEIM, DAPHNE URSULA (PHD CCC-SLP, BCBA)
Entity Type:Individual
Prefix:DR
First Name:DAPHNE
Middle Name:URSULA
Last Name:HARTZHEIM
Suffix:
Gender:F
Credentials:PHD CCC-SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 OLD MAIN HL
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-5400
Mailing Address - Country:US
Mailing Address - Phone:435-797-1375
Mailing Address - Fax:
Practice Address - Street 1:6410 OLD MAIN HL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-5400
Practice Address - Country:US
Practice Address - Phone:435-797-1375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6592345-2506103K00000X
UT6592345-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst