Healthcare Provider Details

I. General information

NPI: 1043803687
Provider Name (Legal Business Name): GARRETT POLLERT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 W 200 S # 213
SALT LAKE CITY UT
84101-1603
US

IV. Provider business mailing address

32 W 200 S # 213
SALT LAKE CITY UT
84101-1603
US

V. Phone/Fax

Practice location:
  • Phone: 701-307-0187
  • Fax:
Mailing address:
  • Phone: 701-307-0187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1376
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number660
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number13436105-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: