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NPI Code Detail

MEDICARE: BEVERLY GARDNER PH.D.

MEDICARE: BEVERLY GARDNER 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
1103T00000XPsychologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1S88033OTHERUTSTERLING

General Provider Information

NPI Number : 1629058623
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEVERLY GARDNER PH.D.
Provider Business Mailing Address
First Line : 1545 E 3300 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-3370
Country : US
Telephone Number : 801-478-2780
Fax Number :
Provider Business Practice Location Address
First Line : 1545 E 3300 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-3370
Country : US
Telephone Number : 801-478-2780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 07/08/2007

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Directions to “ BEVERLY GARDNER PH.D.” Practice Location

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