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General NPI Number Information
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NPI Number | 1679902274
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Entity Type | Individual
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Provider Name | JONI LYNN UTLEY PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 4150 CLEMENT ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94121-1545
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Country | US
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Telephone | 415-944-7472
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Fax |
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Provider Business Mailing Address
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Address Line | 226 HENLEY PL
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City | BAY ST LOUIS
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State | MS
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Zip | 39520-3921
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Country | US
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Telephone | 577-353-5907
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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 | 05051
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY9826
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License Number State | FL
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