Healthcare Provider Details

I. General information

NPI: 1265613731
Provider Name (Legal Business Name): JANET R WARBURTON, PH.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

675 E 2100 S SUITE 250
SALT LAKE CITY UT
84106-1887
US

V. Phone/Fax

Practice location:
  • Phone: 801-484-6149
  • Fax: 801-484-3862
Mailing address:
  • Phone: 801-484-6149
  • Fax: 801-484-3862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number459
License Number StateUT

VIII. Authorized Official

Name: MS. JANET R WARBURTON
Title or Position: OWNER
Credential: PH.D.
Phone: 801-424-6149