Provider Demographics
NPI:1770137531
Name:PANEY, CHRISTIANE NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIANE
Middle Name:NICOLE
Last Name:PANEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7069 S HIGHLAND DR
Mailing Address - Street 2:FL 3
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3724
Mailing Address - Country:US
Mailing Address - Phone:801-441-0882
Mailing Address - Fax:
Practice Address - Street 1:7069 S HIGHLAND DR
Practice Address - Street 2:FL 3
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3724
Practice Address - Country:US
Practice Address - Phone:801-441-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10595791-2501103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1143611Medicaid