Healthcare Provider Details

I. General information

NPI: 1275933244
Provider Name (Legal Business Name): MARGARET LEGARRETA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL DR MAIL CODE 116M
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

500 FOOTHILL DR MAIL CODE 116M
SALT LAKE CITY UT
84148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax:
Mailing address:
  • Phone: 801-582-1565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8433533-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: