UTAH STATE UNIVERSITY (NPI# 1811058076) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811058076 |
| Entity Type | Organization |
| Organization Name | UTAH STATE UNIVERSITY |
| Practice Address |
2810 Old Main Hl Logan UT 84322-2810 |
| Practice Telephone | 4357973401 |
| Practice Fax Number | 4357971448 |
| Mailing Telephone | 4357973401 |
| Mailing Fax Number | 4357971448 |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. KATHY J. RECK (OFFICE MANAGER) |
| Authorized Official Telephone | 4357972032 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
5805022-2501 | UT | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | BLUE CROSS BLUE SHIELD | 5805022250001 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063679785 | Utah State University | Community/Behavioral Health | 6813 Old Main Hill, Logan, UT 84322-6813 | 2008-05-20 |
| 1811054182 | Utah State University | Respite Care | 809 N 800 E, Logan, UT 84321-3634 | 2007-01-03 |
| 1174694095 | Utah State University | Clinic/Center | 6802 Old Main Hill, Logan, UT 84322-6802 | 2006-11-13 |
| 1629619010 | Utah State University | Behavioral Analyst | 6405 Old Main Hill, Logan, UT 84322-0001 | 2019-10-07 |
| 1447715701 | Utah State University | Specialist | 6405 Old Main Hill, Logan, UT 84322-0001 | 2019-01-31 |
| 1144531419 | Utah State University | Day Training, Developmentally Disabled Services | 150 E Center St, Moab, UT 84532-2430 | 2010-07-01 |
| 1235374984 | Utah State University | Speech-Language Pathologist | 6410 Old Main Hl, Logan, UT 84322-6410 | 2008-12-10 |
| 1386776730 | Utah State University | Psychologist | 2810 Old Main Hl, Logan, UT 84322 | 2007-03-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | UTAH STATE UNIVERSITY - COLLEGE OF EASTERN UTAH (BLANDING) | 639 W 100 S Suite 1-A, Blanding, UT 84511-4217 |
| System for Award Management (SAM) Entities | UTAH STATE UNIVERSITY - COLLEGE OF EASTERN UTAH (PRICE) | 451 E 400 N, Price, UT 84501-2626 |
| System for Award Management (SAM) Entities | UTAH STATE UNIVERSITY SPACE DYNAMICS LABORATORY | 1695 N Research Pkwy, North Logan, UT 84341 |
| Street Address |
2810 OLD MAIN HL |
| City | LOGAN |
| State | UT |
| Zip Code | 84322-2810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104858695 | Gretchen Gimpel Peacock | Psychologist | 2810 Old Main Hl, Department of Psychology, Logan, UT 84322-2810 | 2006-07-07 |
| 1881146223 | Rebecca Kate Blais | Psychologist | 2810 Old Main Hl, Logan, UT 84322-2810 | 2016-11-02 |
| 1972730117 | Carolyn Gay Barcus | Psychologist | 2810 Old Main Hl, Logan, UT 84322-2810 | 2009-06-15 |
| 1568581056 | Michael Scott Deberard | Psychologist | 2810 Old Main Hl, Logan, UT 84322-2810 | 2007-03-28 |
| 1386776730 | Utah State University | Psychologist | 2810 Old Main Hl, Logan, UT 84322 | 2007-03-12 |
| 1407983315 | Susan Crowley | Psychologist | 2810 Old Main Hl, Logan, UT 84322-2810 | 2007-02-27 |
| 1285666784 | Melanie Marie Domenech Rodriguez | Psychologist | 2810 Old Main Hl, Dpt. of Psychology, Logan, UT 84322-2810 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447706007 | Conner Andrews | Physician Assistant | 7425 Old Main Hill, Logan, UT 84322 | 2016-09-01 |
| 1841743515 | Kali Leanne Markle | Audiologist | 2620 Old Main Hl, Logan, UT 84322 | 2016-07-29 |
| 1043670011 | Paul Bryan Beachem Iv | Specialist/Technologist | 7400 Old Main Hill, Dale Mildenberger Sports Medicine Complex, Logan, UT 84322 | 2016-03-03 |
| 1508387176 | Matthew Steven Buckner | Specialist/Technologist | 7400 Old Main Hl, Logan, UT 84322 | 2017-07-04 |
| 1366971368 | Caleigh Goode | Specialist/Technologist | 7425 Old Main Hill Athletic Training Room, Logan, UT 84322-0001 | 2017-06-05 |
| 1639319775 | Vicki L. Simonsmeier | Speech-Language Pathologist | Department of Communicative Disorders, 1000 Old Main Hill, Logan, UT 84322-0001 | 2009-03-03 |
| 1730246299 | George Christopher Wootton | Nurse Practitioner | 6802 Old Main Hl, Utah State University, Logan, UT 84322-0001 | 2007-01-03 |
| 1356373807 | Utah State University, Center for Persons With Disabilities | Day Training, Developmentally Disabled Services | 6810 Old Main Hl, Logan, UT 84322-0001 | 2006-07-07 |
| 1801878095 | James Walter Davis | Emergency Medicine | 9100 Old Main Hill, 850 East 1200 North, Logan, UT 84322-0001 | 2005-11-15 |
| 1710592498 | Jacqueline Guymon | Speech-Language Pathologist | 6405 Old Main Hill, Logan, UT 84322-0001 | 2020-09-10 |
| Find all providers in zip 84322 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205433059 | Steven Lucero | Psychologist | 93 S 1250 E, Logan, UT 84321-6770 | 2020-10-05 |
| 1598216731 | Bruce R. Johns, Ph.d., P.C. | Psychologist | 246 E 1260, N, Logan, UT 84341-6244 | 2016-10-24 |
| 1679865000 | Noel Carson Gill | Psychologist | 642 N 1000 W, Ste 107, Logan, UT 84321-3130 | 2011-05-03 |
| 1033408547 | David W. Smart | Psychologist | 175 W 1400 N. Ste A, Lds Family Services, Logan, UT 84341 | 2011-04-05 |
| 1578739215 | Martin J. Toohill | Psychologist | 6813 Old Main Hl, Center for Persons With Disabilities, Logan, UT 84322-6813 | 2008-05-02 |
| 1316097538 | Nicole Smith | Psychologist | Rt. 10 Three Mile Curve, Logan, WV 25601-9998 | 2007-01-11 |
| 1831102052 | Bruce R. Johns | Psychologist | 246 E 1260 N, Logan, UT 84341 | 2006-08-15 |
| 1427062074 | Anthony J Strelich | Psychologist | 1755 N 400 E Ste 102, Logan, UT 84341-1960 | 2006-07-28 |
| 1063044865 | Rick Anthony Cruz | Psychologist | 6405 Old Main Hill, Logan, UT 84322-6405 | 2020-02-10 |
| 1073059580 | Monique Frazier, Ph.d., P.C. | Psychologist | 246 E 1260 N, Logan, UT 84341-7501 | 2017-01-09 |
| Find all providers in LOGAN | ||||
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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.