Provider Demographics
NPI:1295065712
Name:HAMILTON, RYAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9048 S 1660 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-3702
Mailing Address - Country:US
Mailing Address - Phone:801-571-8901
Mailing Address - Fax:
Practice Address - Street 1:9048 S 1660 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-3702
Practice Address - Country:US
Practice Address - Phone:801-571-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT537392235011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical