Healthcare Provider Details

I. General information

NPI: 1497922744
Provider Name (Legal Business Name): CASSANDRA BURNS ROMINE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CHIPETA WAY
SALT LAKE CITY UT
84108-1222
US

IV. Provider business mailing address

336 W BROADWAY STE 315
SALT LAKE CITY UT
84101-1746
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-2500
  • Fax:
Mailing address:
  • Phone: 801-521-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5381053-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: