Mr Jack Davis Haden, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Salt Lake City, Utah. His current practice location is
110 S 800 E Apt 203, Salt Lake City, Utah. You can reach out to his office (for appointments etc.) via phone at
(801) 520-6834.
Mr Jack Davis Haden is licensed to practice in Utah (license number 8928002-3501) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1821396540.
Healthcare Provider's Profile
Full Name | Mr Jack Davis Haden |
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Gender | Male |
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Speciality | Social Worker - Clinical |
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Location | 110 S 800 E Apt 203, Salt Lake City, Utah |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1821396540
- Provider Enumeration Date: 03/03/2011
- Last Update Date: 04/21/2025
Medicare PECOS Information:
- PECOS PAC ID: 5698152510
- Enrollment ID: I20220516001354
Medical Identifiers
Medical identifiers for Mr Jack Davis Haden such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1821396540 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101Y00000X | Counselor | (* (Not Available)) | Secondary |
1041C0700X | Social Worker - Clinical | 8928002-3501 (Utah) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Jack Davis Haden is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mr Jack Davis Haden, LCSW 110 S 800 E Apt 203, Salt Lake City, UT 84102-4145 Ph: (801) 520-6834 | Mr Jack Davis Haden, LCSW 110 S 800 E Apt 203, Salt Lake City, UT 84102-4145 Ph: (801) 520-6834 |
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