Provider Demographics
NPI:1801979927
Name:POMPA, JANIECE LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:JANIECE
Middle Name:LYNN
Last Name:POMPA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 S 1800 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4126
Mailing Address - Country:US
Mailing Address - Phone:801-463-3763
Mailing Address - Fax:
Practice Address - Street 1:4505 WASATCH BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-4709
Practice Address - Country:US
Practice Address - Phone:801-273-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112537-2501103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist