MEDICARE: LIZ HALE, 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	310400000X	Assisted Living Facility	5234322-2501	UT

General Provider Information

NPI Number	:	1295929149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIZ HALE, PH.D.

Provider Business Mailing Address
First Line	:	702 E SOUTH TEMPLE
Second Line	:	SUITE B-20
City	:	SLC
State	:	UT
Zip	:	84102-1204
Country	:	US
Telephone Number	:	801-363-2245
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 E SOUTH TEMPLE
Second Line	:	SUITE B-20
City	:	SLC
State	:	UT
Zip	:	84102-1204
Country	:	US
Telephone Number	:	801-363-2245
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LIZ HALE
Credential	:	PH.D.
Telephone Number	:	801-328-2164

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	10/31/2007

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