MEDICARE: DR. COLLEEN MARIE KUHN 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	103TC2200X	Clinical Child & Adolescent Psychologist	5989734-2504	UT

General Provider Information

NPI Number	:	1467557314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN MARIE KUHN PH. D.

Provider Business Mailing Address
First Line	:	407 KENSINGTON AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-1719
Country	:	US
Telephone Number	:	801-455-5626
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 S 1000 E
Second Line	:	SUITE 210
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1428
Country	:	US
Telephone Number	:	801-355-3554
Fax Number	:	801-355-3711

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/13/2013

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