Healthcare Provider Details

I. General information

NPI: 1992073118
Provider Name (Legal Business Name): LINDSEY WYNONA NORTH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 02/12/2015
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 Code103TC0700X
TaxonomyClinical Psychologist
License Number8977008-2501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: