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NPI Code Detail

MEDICARE: THE AUTISM CLINIC

MEDICARE: THE AUTISM CLINIC
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
1103T00000XPsychologist

General Provider Information

NPI Number : 1073276390
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE AUTISM CLINIC
Provider Business Mailing Address
First Line : 1537 S MAIN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-5315
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1537 S MAIN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-5315
Country : US
Telephone Number : 385-777-9444
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JULIA CONNELLY
Credential :
Telephone Number : 801-792-9922
Provider Enumeration Date : 10/14/2021
Last Update Date : 09/09/2024

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Directions to “THE AUTISM CLINIC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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