Provider Demographics
NPI:1386776730
Name:UTAH STATE UNIVERSITY
Entity type:Organization
Organization Name:UTAH STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING LEAD
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-797-1346
Mailing Address - Street 1:6405 OLD MAIN HL
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-6405
Mailing Address - Country:US
Mailing Address - Phone:435-797-1346
Mailing Address - Fax:435-797-1448
Practice Address - Street 1:2810 OLD MAIN HL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322
Practice Address - Country:US
Practice Address - Phone:435-797-3401
Practice Address - Fax:435-797-1448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTAH STATE UNIVERSIRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-12
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty