Provider Demographics
NPI:1366719601
Name:TSCHANZ, JOANN T (PHD)
Entity type:Individual
Prefix:PROF
First Name:JOANN
Middle Name:T
Last Name:TSCHANZ
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 1:2810 OLD MAIN HILL
Mailing Address - Street 2:UTAH STATE UNIVERSITY
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-2810
Mailing Address - Country:US
Mailing Address - Phone:435-797-1457
Mailing Address - Fax:
Practice Address - Street 1:2810 OLD MAIN HILL
Practice Address - Street 2:UTAH STATE UNIVERSITY
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-2810
Practice Address - Country:US
Practice Address - Phone:435-797-1457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT265231-2501103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical