Healthcare Provider Details

I. General information

NPI: 1013923655
Provider Name (Legal Business Name): BRUCE DENNIS ETRINGER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 E 2100 S STE 250
SALT LAKE CITY UT
84106-5318
US

IV. Provider business mailing address

675 E 2100 S STE 250
SALT LAKE CITY UT
84106-5318
US

V. Phone/Fax

Practice location:
  • Phone: 801-467-8890
  • Fax: 801-484-3862
Mailing address:
  • Phone: 801-467-8890
  • Fax: 801-484-3862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number114938-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: