Healthcare Provider Details

I. General information

NPI: 1710045679
Provider Name (Legal Business Name): DIANE HILL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 MURRAY HOLLADAY RD SUITE 222
SALT LAKE CITY UT
84117-5185
US

IV. Provider business mailing address

PO BOX 9322
SALT LAKE CITY UT
84109-0322
US

V. Phone/Fax

Practice location:
  • Phone: 801-278-0499
  • Fax: 801-278-0489
Mailing address:
  • Phone: 801-278-0499
  • Fax: 801-278-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number116752-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: