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NPI Code Detail

MEDICARE: U-U ALCOHOL & DRUG CLINIC SCHOOL OF MEDICINE

MEDICARE: U-U ALCOHOL & DRUG CLINIC SCHOOL OF MEDICINE
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
1103TA0400XAddiction (Substance Use Disorder) Psychologist12188UT

General Provider Information

NPI Number : 1245371699
Entity Type Code : Organization
Provider Name (Legal Business Name) : U-U ALCOHOL & DRUG CLINIC SCHOOL OF MEDICINE
Provider Business Mailing Address
First Line : 30 N 1900 E
Second Line : 1R52 SOM
City : SALT LAKE CITY
State : UT
Zip : 84132-2119
Country : US
Telephone Number : 801-581-6228
Fax Number : 801-585-6702
Provider Business Practice Location Address
First Line : 30 N 1900 E
Second Line : 1R52 SOM
City : SALT LAKE CITY
State : UT
Zip : 84132-2119
Country : US
Telephone Number : 801-581-6228
Fax Number : 801-585-6702
Authorized Official
Title or Position : DIRECTOR
Name : DR. STEPHEN SHEPPARD
Credential : PHD
Telephone Number : 801-581-6228
Provider Enumeration Date : 02/09/2007
Last Update Date : 02/29/2012

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Directions to “U-U ALCOHOL & DRUG CLINIC SCHOOL OF MEDICINE ” Practice Location

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