Provider Demographics
NPI:1962696930
Name:HOGLUND, MICHAEL JOEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOEL
Last Name:HOGLUND
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 1:13351 S 7300 W
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-4671
Mailing Address - Country:US
Mailing Address - Phone:801-302-7202
Mailing Address - Fax:801-587-3192
Practice Address - Street 1:13351 S 7300 W
Practice Address - Street 2:HERRIMAN
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-4671
Practice Address - Country:US
Practice Address - Phone:801-302-7202
Practice Address - Fax:801-587-3192
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120703-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical