MEDICARE: DR. JOSHUA J CLUFF PSYD

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	6962799-2504	UT

General Provider Information

NPI Number	:	1245469352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA J CLUFF PSYD

Provider Business Mailing Address
First Line	:	365 W 800 N
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-1418
Country	:	US
Telephone Number	:	541-647-4217
Fax Number	:

Provider Business Practice Location Address
First Line	:	365 W 800 N
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-1418
Country	:	US
Telephone Number	:	541-647-4217
Fax Number	:

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

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	07/09/2009

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