Healthcare Provider Details

I. General information

NPI: 1235815275
Provider Name (Legal Business Name): JARED ISAAC CLINE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 NORTH 1525 WEST SUITE 213
FARMINGTON UT
84025
US

IV. Provider business mailing address

775 N 1525 W STE 213
FARMINGTON UT
84025-4815
US

V. Phone/Fax

Practice location:
  • Phone: 801-540-6860
  • Fax: 888-355-0195
Mailing address:
  • Phone: 801-540-6860
  • Fax: 888-355-0195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number14272011-2501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number14272011-2501
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number14272011-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: