Individual
HEATHER FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
670 12TH ST, OGDEN, UT 84404-5877
(801) 781-5733
Mailing address
670 12TH ST, OGDEN, UT 84404-5877
(801) 781-5733
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13525650-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055266
MEDICARE PIN
UT
01
—
260022408
RAILROAD MEDICARE
UT
05
—
8760003008007
—
UT
Enumeration date
08/29/2022
Last updated
01/02/2026
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