Healthcare Provider Details

I. General information

NPI: 1497726186
Provider Name (Legal Business Name): SCOTT W. KADERA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 S. HIGHLAND DR, SUITE 100
SALT LAKE CITY UT
84124
US

IV. Provider business mailing address

635 DOWNINGTON AVE
SALT LAKE CITY UT
84105-3020
US

V. Phone/Fax

Practice location:
  • Phone: 801-273-1085
  • Fax:
Mailing address:
  • Phone: 801-323-0625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4827325-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: