Healthcare Provider Details

I. General information

NPI: 1801979927
Provider Name (Legal Business Name): JANIECE LYNN POMPA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 WASATCH BLVD SUITE 330
SALT LAKE CITY UT
84124-4709
US

IV. Provider business mailing address

2129 S 1800 E
SALT LAKE CITY UT
84106-4126
US

V. Phone/Fax

Practice location:
  • Phone: 801-273-7555
  • Fax:
Mailing address:
  • Phone: 801-463-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number112537-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: