Healthcare Provider Details

I. General information

NPI: 1194940908
Provider Name (Legal Business Name): NANCI C. KLEIN, PH.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E 200 S SUITE 303
SALT LAKE CITY UT
84102-2022
US

IV. Provider business mailing address

505 E 200 S SUITE 303
SALT LAKE CITY UT
84102-2022
US

V. Phone/Fax

Practice location:
  • Phone: 801-350-0116
  • Fax: 801-350-9582
Mailing address:
  • Phone: 801-350-0116
  • Fax: 801-350-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1139762501
License Number StateUT

VIII. Authorized Official

Name: DR. NANCI CAROL KLEIN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 801-350-0116