Healthcare Provider Details

I. General information

NPI: 1093397010
Provider Name (Legal Business Name): SPENCER LOONG PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 W EXECUTIVE PKWY STE 274
LEHI UT
84048-9642
US

IV. Provider business mailing address

2975 W EXECUTIVE PARKWAY #156
LEHI UT
84048
US

V. Phone/Fax

Practice location:
  • Phone: 801-787-9972
  • Fax:
Mailing address:
  • Phone: 801-787-9972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number14249576-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: