Provider Demographics
NPI:1477755148
Name:POFF, ANN HACKING (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:HACKING
Last Name:POFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ANN
Other - Middle Name:HACKING
Other - Last Name:GAWRYS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:318 EAST RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-2602
Mailing Address - Country:US
Mailing Address - Phone:801-763-8592
Mailing Address - Fax:
Practice Address - Street 1:318 RIDGE DR
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-2602
Practice Address - Country:US
Practice Address - Phone:801-763-8592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5138533-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical