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General NPI Number Information
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NPI Number | 1558059477
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Entity Type | Individual
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Provider Name | KADE MARTINEAU
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Gender | Male
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 940 N 400 E STE 206
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-1985
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Country | US
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Telephone | 435-557-0758
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Fax |
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Provider Business Mailing Address
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Address Line | 940 N 400 E STE 206
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-1985
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Country | US
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Telephone |
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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 | 8686166-2501
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License Number State | UT
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