Healthcare Provider Details

I. General information

NPI: 1659106011
Provider Name (Legal Business Name): ANN-MICHELLE NEAL ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E 1ST AVE APT 2
SALT LAKE CITY UT
84103-3403
US

IV. Provider business mailing address

603 E 1ST AVE APT 2
SALT LAKE CITY UT
84103-3403
US

V. Phone/Fax

Practice location:
  • Phone: 801-735-9971
  • Fax:
Mailing address:
  • Phone: 801-735-9971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number17594746
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number560187
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: