=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952466690
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATION FOR PERSONAL DEVELOPMENT PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 02/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 447 N 300 W STE 7
-----------------------------------------------------
City | KAYSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84037-4203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-529-7087
-----------------------------------------------------
Fax | 801-544-6558
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 690 E CENTER ST
-----------------------------------------------------
City | KAYSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84037-2137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-544-1166
-----------------------------------------------------
Fax | 801-544-6558
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANN F. PRITT
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 801-544-1166
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | (94)1410173501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------