Healthcare Provider Details

I. General information

NPI: 1083495287
Provider Name (Legal Business Name): BECCA HUBER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 N MEDICAL DR
SALT LAKE CITY UT
84112-1100
US

IV. Provider business mailing address

85 N MEDICAL DR
SALT LAKE CITY UT
84112-1100
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7985
  • Fax:
Mailing address:
  • Phone: 801-581-7985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number13514131-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: