MEDICARE: DR. JANIECE LYNN POMPA 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	103G00000X	Clinical Neuropsychologist	112537-2501	UT

General Provider Information

NPI Number	:	1801979927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANIECE LYNN POMPA PH.D.

Provider Business Mailing Address
First Line	:	2129 S 1800 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4126
Country	:	US
Telephone Number	:	801-463-3763
Fax Number	:

Provider Business Practice Location Address
First Line	:	4505 WASATCH BLVD
Second Line	:	SUITE 330
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-4709
Country	:	US
Telephone Number	:	801-273-7555
Fax Number	:

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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