Healthcare Provider Details

I. General information

NPI: 1780837047
Provider Name (Legal Business Name): ADAM J SCHWEBACH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 N 2000 W SUITE E
CLINTON UT
84015-8638
US

IV. Provider business mailing address

PO BOX 95970
SOUTH JORDAN UT
84095-0970
US

V. Phone/Fax

Practice location:
  • Phone: 801-614-5866
  • Fax: 801-825-1162
Mailing address:
  • Phone: 800-658-8556
  • Fax: 801-352-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number360871-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: