MEDICARE: DR. STEPHEN HAMILTON PRASAD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1063159648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN HAMILTON PRASAD PH.D.

Provider Business Mailing Address
First Line	:	2500 S STATE ST
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-3164
Country	:	US
Telephone Number	:	385-646-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6034 W MILL VALLEY LN
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84118-9315
Country	:	US
Telephone Number	:	385-646-2336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/16/2022

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