Healthcare Provider Details

I. General information

NPI: 1649360231
Provider Name (Legal Business Name): DEIRDRE ANNE LEVSTEK CAPLIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

PO BOX 581100
SALT LAKE CITY UT
84158-1100
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-3501
  • Fax:
Mailing address:
  • Phone: 801-213-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4906953-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: