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General NPI Number Information
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NPI Number | 1285438077
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Entity Type | Individual
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Provider Name | ABIGAIL ELIZABETH GOODRIDGE PHD
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Gender | Female
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 51 W 3900 S
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City | MILLCREEK
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State | UT
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Zip | 84107-1431
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Country | US
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Telephone | 801-646-7836
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Fax |
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Provider Business Mailing Address
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Address Line | 842 S 1100 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-3709
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Country | US
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Telephone | 207-975-1939
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 14167857-2501
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License Number State | UT
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