MEDICARE: SARAH T HUBBARD 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	7994644-2501	UT

General Provider Information

NPI Number	:	1366473159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH T HUBBARD PH D

Provider Business Mailing Address
First Line	:	428 I ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-3141
Country	:	US
Telephone Number	:	443-864-3365
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 S 700 E STE 102
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2509
Country	:	US
Telephone Number	:	443-864-3365
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/03/2020

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