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General NPI Number Information
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NPI Number | 1013111996
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Entity Type | Individual
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Provider Name | CHARLOTTE J FERRIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 1399 S 700 E SUITE 11
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City | SALT LAKE CITY
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State | UT
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Zip | 84105-2149
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Country | US
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Telephone | 801-231-5795
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Fax |
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Provider Business Mailing Address
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Address Line | 2915 E MILLICENT DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-2019
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Country | US
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Telephone | 801-582-4147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4911648-2501
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License Number State | UT
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