Healthcare Provider Details

I. General information

NPI: 1992000145
Provider Name (Legal Business Name): LORI NEELEMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 SOUTH 900 EAST
SALT LAKE CITY UT
84102-2310
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 385-282-2000
  • Fax: 385-282-2001
Mailing address:
  • Phone: 385-282-2000
  • Fax: 385-282-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5408755-2501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5408755-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: