Healthcare Provider Details

I. General information

NPI: 1962260992
Provider Name (Legal Business Name): FEEA LEIFKER PHD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S CENTRAL CAMPUS DR STE 3525
SALT LAKE CITY UT
84112-9199
US

IV. Provider business mailing address

380 S 1530 E RM 502
SALT LAKE CITY UT
84112-0251
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-4697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10221144-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: