Healthcare Provider Details

I. General information

NPI: 1699861997
Provider Name (Legal Business Name): NANCI CAROL KLEIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/21/2022
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 Number113976-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: