MEDICARE: DR. STUART R DRESCHER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	115822-2501	UT

General Provider Information

NPI Number	:	1053638221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART R DRESCHER PH.D.

Provider Business Mailing Address
First Line	:	77 S 700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1138
Country	:	US
Telephone Number	:	801-483-2714
Fax Number	:	801-483-3010

Provider Business Practice Location Address
First Line	:	77 S 700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1138
Country	:	US
Telephone Number	:	801-483-2714
Fax Number	:	801-483-3010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	04/28/2010

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