Healthcare Provider Details

I. General information

NPI: 1366473159
Provider Name (Legal Business Name): SARAH T HUBBARD PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 S 700 E STE 102
SALT LAKE CITY UT
84107-2509
US

IV. Provider business mailing address

428 I ST
SALT LAKE CITY UT
84103-3141
US

V. Phone/Fax

Practice location:
  • Phone: 443-864-3365
  • Fax:
Mailing address:
  • Phone: 443-864-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7994644-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: