Provider Demographics
NPI:1265404032
Name:HOPPS, KENNETH JOHN (PHD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOHN
Last Name:HOPPS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4487 ARCADIA LN
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3507
Mailing Address - Country:US
Mailing Address - Phone:801-277-7099
Mailing Address - Fax:
Practice Address - Street 1:1141 E 3900 S
Practice Address - Street 2:SUITE A-170
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1215
Practice Address - Country:US
Practice Address - Phone:801-270-6534
Practice Address - Fax:801-284-4991
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT117202501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT261747OtherDMBA
UT107011572101OtherIHC
UT942938348HO6OtherEDUCATOR'S MUTUAL
UT005763504Medicare PIN
UT004662100Medicare PIN
UT261747OtherDMBA