Healthcare Provider Details

I. General information

NPI: 1225200033
Provider Name (Legal Business Name): STEPHANIE LOUISE TONIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 ALMOND ST
SALT LAKE CITY UT
84103-1639
US

IV. Provider business mailing address

309 ALMOND ST
SALT LAKE CITY UT
84103-1639
US

V. Phone/Fax

Practice location:
  • Phone: 801-870-8087
  • Fax:
Mailing address:
  • Phone: 801-870-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5334406-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: