| Aging Clinic Of Southern Utah Pllc | |
|
94 S 300 E Cedar City UT 84720-3318 | |
| (435) 277-0285 | |
| Not Available |
| Full Name | Aging Clinic Of Southern Utah Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 94 S 300 E, Cedar City, Utah |
| Authorized Official Name and Position | Kirsten Leigh Graham (OWNER/PROVIDER) |
| Authorized Official Contact | 4352770285 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aging Clinic Of Southern Utah Pllc 94 S 300 E Cedar City UT 84720-3318 Ph: (435) 277-0285 | Aging Clinic Of Southern Utah Pllc 94 S 300 E Cedar City UT 84720-3318 Ph: (435) 277-0285 |
| NPI Number | 1043091960 |
|---|---|
| Provider Enumeration Date | 10/06/2023 |
| Last Update Date | 02/20/2024 |
| Certification Date | 02/20/2024 |
| Medicare PECOS PAC ID | 2365886132 |
|---|---|
| Medicare Enrollment ID | O20240220003004 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043091960 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Kirsten Leigh Graham |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376165530 PECOS PAC ID: 6002250875 Enrollment ID: I20240220002980 |
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