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NPI Code Detail

MEDICARE: ANGELA ENNO PH.D.

MEDICARE: ANGELA ENNO 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
1103T00000XPsychologist11762359-2501UT

General Provider Information

NPI Number : 1386456044
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA ENNO PH.D.
Provider Business Mailing Address
First Line : 201 S 1460 E RM 426
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84112-9061
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 201 S 1460 E RM 426
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84112-9061
Country : US
Telephone Number : 801-586-6826
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2025
Last Update Date : 01/21/2025

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