Individual
MICHAEL HACKING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4460 S HIGHLAND DR, SALT LAKE CITY, UT 84124-3543
(888) 949-4864
Mailing address
4460 S HIGHLAND DR, SALT LAKE CITY, UT 84124-3543
(888) 949-4864
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
5804920-3102
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5804920-4405
UT
Other
Enumeration date
01/16/2019
Last updated
03/20/2020
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