Healthcare Provider Details

I. General information

NPI: 1821273772
Provider Name (Legal Business Name): KIRK R DANSIE PSY.D., M.S.C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 PIONEER ST
SALT LAKE CITY UT
84109-3048
US

IV. Provider business mailing address

3370 PIONEER ST
SALT LAKE CITY UT
84109-3048
US

V. Phone/Fax

Practice location:
  • Phone: 801-484-6892
  • Fax:
Mailing address:
  • Phone: 801-484-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5412520-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: