Healthcare Provider Details

I. General information

NPI: 1962955112
Provider Name (Legal Business Name): ROBERT D HILL PHD, ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S 500 E STE 101
SALT LAKE CITY UT
84102-1039
US

IV. Provider business mailing address

34 S 500 E STE 101
SALT LAKE CITY UT
84102-1039
US

V. Phone/Fax

Practice location:
  • Phone: 385-227-8941
  • Fax: 385-227-8941
Mailing address:
  • Phone: 385-227-8941
  • Fax: 385-227-8941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number115278-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: