MEDICARE: DR. LINNEA SMITH NOYES 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	103T00000X	Psychologist	4770249-2501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14770249202001	OTHER	UT	REGENCE BCBS
2	14770249202001	OTHER	UT	REGENCE VALUECARE

General Provider Information

NPI Number	:	1528285186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINNEA SMITH NOYES PH.D.

Provider Business Mailing Address
First Line	:	204 CANYON RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2554
Country	:	US
Telephone Number	:	801-531-7464
Fax Number	:	801-532-3387

Provider Business Practice Location Address
First Line	:	204 CANYON RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2554
Country	:	US
Telephone Number	:	801-531-7464
Fax Number	:	801-532-3387

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/09/2007

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