Healthcare Provider Details

I. General information

NPI: 1639524895
Provider Name (Legal Business Name): ELIZABETH CRAUN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N 400 W APT 3024
SALT LAKE CITY UT
84103-1517
US

IV. Provider business mailing address

255 N 400 W APT 3024
SALT LAKE CITY UT
84103-1517
US

V. Phone/Fax

Practice location:
  • Phone: 702-408-2663
  • Fax:
Mailing address:
  • Phone: 702-408-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number12413480-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: