Provider Demographics
NPI:1063741429
Name:HAWKS, RICKY D (EDD)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:D
Last Name:HAWKS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 N 850 E
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2414
Mailing Address - Country:US
Mailing Address - Phone:801-782-3551
Mailing Address - Fax:801-782-3551
Practice Address - Street 1:5677 S 1475 E
Practice Address - Street 2:SUITE 4A
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-7032
Practice Address - Country:US
Practice Address - Phone:801-621-6032
Practice Address - Fax:801-409-0905
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT115258-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT87-0549642OtherSIN