Provider Demographics
NPI:1558923144
Name:HARDWICK, OLIVIA ANNE (CSW)
Entity Type:Individual
Prefix:MR
First Name:OLIVIA
Middle Name:ANNE
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MISS
Other - First Name:OLIVIA
Other - Middle Name:ANNE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 W FOX PARK DR APT 4O
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-7925
Mailing Address - Country:US
Mailing Address - Phone:301-752-4855
Mailing Address - Fax:
Practice Address - Street 1:TRANSITIONS AT SLRMC
Practice Address - Street 2:86 S. 1100 E. SUITE 404
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102
Practice Address - Country:US
Practice Address - Phone:801-350-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11057597-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker