Healthcare Provider Details

I. General information

NPI: 1649964461
Provider Name (Legal Business Name): SALT LAKE NEUROPSYCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 W 11400 S # 104
SOUTH JORDAN UT
84095-8960
US

IV. Provider business mailing address

1314 W 11400 S # 104
SOUTH JORDAN UT
84095-8960
US

V. Phone/Fax

Practice location:
  • Phone: 385-274-8113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIN ELIZABETH KRAUSKOPF
Title or Position: PARTNER; PEDIATRIC NEUROPSYCHOLOGIS
Credential: PHD
Phone: 772-233-9230