Provider Demographics
NPI:1124789904
Name:DOTY, HANNAH (CSW)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:DOTY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 W 13400 S STE 100
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6483
Mailing Address - Country:US
Mailing Address - Phone:801-515-5850
Mailing Address - Fax:
Practice Address - Street 1:4651 W 13400 S STE 100
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6483
Practice Address - Country:US
Practice Address - Phone:801-515-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12288147-3502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health