MEDICARE: ERIN CATHERINE MCGLADE PHD

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	7120186-2501	UT

General Provider Information

NPI Number	:	1881994424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN CATHERINE MCGLADE PHD

Provider Business Mailing Address
First Line	:	1572 PARK ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2011
Country	:	US
Telephone Number	:	801-707-8811
Fax Number	:

Provider Business Practice Location Address
First Line	:	1572 PARK ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2011
Country	:	US
Telephone Number	:	801-707-8811
Fax Number	:

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

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	12/20/2021

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