Provider Demographics
NPI:1871275214
Name:LYNGUYEN, RILEY HAACKE
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:HAACKE
Last Name:LYNGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RILEY
Other - Middle Name:BREANN
Other - Last Name:HAACKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3206
Mailing Address - Country:US
Mailing Address - Phone:206-919-0891
Mailing Address - Fax:
Practice Address - Street 1:331 S RIO GRANDE ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1136
Practice Address - Country:US
Practice Address - Phone:801-485-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker