Provider Demographics
NPI:1649964461
Name:SALT LAKE NEUROPSYCH
Entity type:Organization
Organization Name:SALT LAKE NEUROPSYCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER; PEDIATRIC NEUROPSYCHOLOGIS
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KRAUSKOPF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:772-233-9230
Mailing Address - Street 1:1314 W 11400 S # 104
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1314 W 11400 S # 104
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8960
Practice Address - Country:US
Practice Address - Phone:385-274-8113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty