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General NPI Number Information
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NPI Number | 1801838602
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Entity Type | Individual
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Provider Name | RONNIE JAMES LLEWELYN PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 660 S 200 E SUITE 308
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-3835
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Country | US
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Telephone | 801-355-2846
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Fax | 801-359-3244
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Provider Business Mailing Address
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Address Line | 135 EAST WASATCH POINT LN #27-101
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City | DRAPER
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State | UT
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Zip | 84020
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Country | US
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Telephone | 858-775-6516
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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 | 6209081-2504
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License Number State | UT
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