Provider Demographics
NPI:1477114205
Name:HIDALGO, RYAN (SUDC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:SUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 HERITAGE PARK BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5611
Mailing Address - Country:US
Mailing Address - Phone:801-251-7251
Mailing Address - Fax:
Practice Address - Street 1:523 HERITAGE PARK BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5611
Practice Address - Country:US
Practice Address - Phone:801-251-7251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor