Aging Clinic of Southern Utah PLLC
Organization Active NPI Psychologist · Cedar City, UT
NPI 1043091960 · NPPES record last updated Feb 20, 2024
Key facts
- NPI
- 1043091960
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychologist 103T00000X
- Legal business name
- AGING CLINIC OF SOUTHERN UTAH PLLC
- Practice address
- 94 S 300 E
Cedar City, UT 84720-3318 - Phone
- (435) 277-0285
- NPI assigned
- Oct 6, 2023
- Organization subpart
- No
Authorized official
- Name
- Kirsten Leigh Graham, PHD
- Title
- Owner/Provider
- Phone
- (435) 277-0285
Practitioners 1
-
Kirsten Leigh Graham, PH.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240220003004 | UT | Part B Supplier - Clinic/Group Practice | 2365886132 |
Receives reassigned benefits from 1 practitioner Practice locations: Cedar City, UT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | Yes |
Addresses
Primary practice location
94 S 300 E
Cedar City, UT 84720-3318
Mailing address
94 S 300 E
Cedar City, UT 84720-3318
Phone (435) 277-0285
Other providers in Cedar City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.