MEDICARE: LEONARD JARED HAAS 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	103TC0700X	Clinical Psychologist	00318-2501-4	UT

General Provider Information

NPI Number	:	1154380533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD JARED HAAS PH.D.

Provider Business Mailing Address
First Line	:	375 CHIPETA WAY
Second Line	:	SUITE A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1260
Country	:	US
Telephone Number	:	801-587-3401
Fax Number	:	801-581-2771

Provider Business Practice Location Address
First Line	:	375 CHIPETA WAY
Second Line	:	SUITE A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1260
Country	:	US
Telephone Number	:	801-587-3401
Fax Number	:	801-581-2771

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	07/08/2007

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