=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073083929
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDRICK A. RITH PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2018
-----------------------------------------------------
Last Update Date | 04/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10432 S 4000 W STE B
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84009-5729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-923-2253
-----------------------------------------------------
Fax | 385-247-5088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10432 S 4000 W STE B
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84009-5729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-923-2253
-----------------------------------------------------
Fax | 385-247-5088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 10499907-2501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------