MEDICARE: DR. ELIZABETH 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	103TP0016X	Prescribing (Medical) Psychologist	5234322-2501	UT

General Provider Information

NPI Number	:	1578765624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH HALE PH.D.

Provider Business Mailing Address
First Line	:	838 E SOUTH TEMPLE APT 111
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1342
Country	:	US
Telephone Number	:	801-363-2245
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 E SOUTH TEMPLE STE B-20
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1204
Country	:	US
Telephone Number	:	801-520-6580
Fax Number	:

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	07/08/2007

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