Healthcare Provider Details

I. General information

NPI: 1801846969
Provider Name (Legal Business Name): MICHAEL DALE STEFFEN PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 N MEDICAL DR
SALT LAKE CITY UT
84113-1105
US

IV. Provider business mailing address

3041 PLATEAU DR
SALT LAKE CITY UT
84109-2320
US

V. Phone/Fax

Practice location:
  • Phone: 801-584-8246
  • Fax:
Mailing address:
  • Phone: 801-484-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberXXXX-XXXX
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: