STEIN MANN INSTITUTE, LLC (NPI# 1215215181) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215215181 |
| Entity Type | Organization |
| Organization Name | STEIN MANN INSTITUTE, LLC |
| Practice Address |
10 W Broadway Ste 820 Salt Lake City UT 84101-2000 |
| Practice Telephone | 8012905320 |
| Practice Fax Number | 8012905321 |
| Mailing Telephone | 8017164284 |
| Mailing Fax Number | 8014330691 |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2016-01-28 |
| Authorized Official Name | DR. LISA MICHELLE SUGERMAN (OWNER) |
| Authorized Official Telephone | 8017164284 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
7821510-1205 | UT | Ambulatory Health Care Facilities |
| Y | 103G00000X | Clinical Neuropsychologist | 6278375-2501 | UT | Behavioral Health & Social Service Providers |
| Street Address |
10 W BROADWAY STE 820 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84101-2000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053804237 | Holly Smith | Registered Nurse | 1020 S Main Street, Salt Lake City, UT 84101 | 2018-06-12 |
| 1174999627 | Justin Williams | Social Worker | 155 W. 300 S., Salt Lake City, UT 84101 | 2015-08-19 |
| 1902291842 | Daryl Ray Ezidore | Student in an Organized Health Care Education/Training Program | 100 South 344 East, Salt Lake City, UT 84101 | 2015-03-30 |
| 1104190859 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 50 S Main St Ste 115, Salt Lake City, UT 84101 | 2012-02-28 |
| 1366713307 | Gonstead Family Chiropractic | Chiropractor | 1154 S. 300 W., Suite C, Salt Lake City, UT 84101 | 2012-01-23 |
| 1659544880 | Jeffrey Daniel | Registered Nurse | 404 South 400 West, Salt Lake City, UT 84101 | 2008-04-09 |
| 1306030580 | Christopher Dean Chapman | Chiropractor | 345 W 100 S Ste 6c, Salt Lake City, UT 84101 | 2007-08-30 |
| 1689713497 | Walter Landon Bye | Dentist | 15 West South Temple, Gateway Tower West Suite 440, Salt Lake City, UT 84101 | 2007-02-06 |
| 1154403152 | Allison Miller Gardner | Physical Therapist | 84 West 700 South, Salt Lake City, UT 84101 | 2006-10-19 |
| 1780655407 | Frederick Van Der Veur | Social Worker | 1020 South Main Street, 242, Salt Lake City, UT 84101 | 2006-01-30 |
| Find all providers in zip 84101 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770954356 | Erin Elizabeth Krauskopf | Clinical Neuropsychologist | 231 E 400 S Ste 335, Salt Lake City, UT 84111-2806 | 2015-10-08 |
| 1528469947 | Jordan Harris Rigby | Clinical Neuropsychologist | 230 S 500 E Ste 100, Salt Lake City, UT 84102-2048 | 2014-09-05 |
| 1154565729 | Keith Mcgoldrick | Clinical Neuropsychologist | 1733 S 1100 E Ste 102, Salt Lake City, UT 84105-3482 | 2009-04-27 |
| 1356593297 | Dustin Bradshaw Hammers | Clinical Neuropsychologist | 650 Komas Dr Ste 106a, Salt Lake City, UT 84108-1225 | 2008-10-22 |
| 1770612863 | Elaine Clark | Clinical Neuropsychologist | 501 Chipita Way, Univ of Utah Neuropsychiatric Institute, Salt Lake City, UT 84108 | 2007-03-05 |
| 1245251776 | Kelly D Garrett | Clinical Neuropsychologist | 333 South 900 East, Salt Lake City, UT 84102-2310 | 2006-07-21 |
| 1831150374 | Juan A. Mejia | Clinical Neuropsychologist | 327 Denver St, Salt Lake City, UT 84111-3002 | 2006-03-31 |
| 1295720969 | Kevin Duff | Clinical Neuropsychologist | 650 Komas Dr, 106a, Salt Lake City, UT 84108-1215 | 2005-09-19 |
| 1518453406 | Joseph Un Kim | Clinical Neuropsychologist | 501 S Chipeta Way, Salt Lake City, UT 84108-1222 | 2018-07-03 |
| 1912362591 | Kelly Konopacki | Clinical Neuropsychologist | 501 Chipeta Way, Salt Lake City, UT 84108 | 2015-12-23 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84101 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.