Provider Demographics
NPI:1467233866
Name:HACKFORD, ALEXIS NOURI (CSW)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NOURI
Last Name:HACKFORD
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7902 S CHADBOURNE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5809
Mailing Address - Country:US
Mailing Address - Phone:801-656-8103
Mailing Address - Fax:
Practice Address - Street 1:718 S 600 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3306
Practice Address - Country:US
Practice Address - Phone:801-467-2863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9661338-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker