Healthcare Provider Details

I. General information

NPI: 1790627420
Provider Name (Legal Business Name): KYLIE MARIE BURDGE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

363 E 1200 S STE 201
OREM UT
84058-6904
US

IV. Provider business mailing address

336 E UNIVERSITY PKWY # 1185
OREM UT
84058-7602
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-2313
  • Fax:
Mailing address:
  • Phone: 801-224-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number14281285-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: