Provider Demographics
NPI:1265719876
Name:HAZEN, SHAWN L (LCSW)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:L
Last Name:HAZEN
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 1:348 E 4500 S
Mailing Address - Street 2:STE 360
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3906
Mailing Address - Country:US
Mailing Address - Phone:385-272-4292
Mailing Address - Fax:866-855-3582
Practice Address - Street 1:348 E 4500 S
Practice Address - Street 2:STE 360
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3906
Practice Address - Country:US
Practice Address - Phone:385-272-4292
Practice Address - Fax:866-855-3582
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8678756-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical