Healthcare Provider Details

I. General information

NPI: 1255702924
Provider Name (Legal Business Name): KALI RODGERS LANTRIP PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 971
CENTERVILLE UT
84014-0971
US

IV. Provider business mailing address

PO BOX 971
CENTERVILLE UT
84014-0971
US

V. Phone/Fax

Practice location:
  • Phone: 805-795-2182
  • Fax:
Mailing address:
  • Phone: 805-795-2182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: