Kent W Anderson PHD PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

324469-2501 Issued in UT

Legal business name

KENT W ANDERSON PHD PC

Practice address

545 W 465 N
Suite 130
Providence, UT 84332-8003

Phone

(435) 752-7627

Fax

(435) 752-7802

NPI assigned

Jan 27, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kent W Anderson, PHDNPI 1932231016

Title

President/Owner

Phone

(435) 752-7627

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kent W Anderson, PHD

  • Clinical Psychologist
  • Providence, UT
  • NPI 1932231016

  UT

  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264550400000",
    "number": "1255662425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 W 465 N",
            "address_2": "SUITE 130",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843328003",
            "telephone_number": "435-752-7627",
            "fax_number": "435-752-7802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 W 465 N",
            "address_2": "SUITE 130",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843328003",
            "telephone_number": "435-752-7627",
            "fax_number": "435-752-7802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENT W ANDERSON PHD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-27",
        "last_updated": "2010-01-27",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "435-752-7627",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "UT",
            "license": "324469-2501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kasaundra D Jorgensen, RBT
• Elisabeth Ann Juhasz
• Benjamin R Kadas, APN
• McKensie Kaplan, LCSW
• Bryton Ben Kaufman
• Kevin R Duke, DO, PC
• Rebecca Anne King, LCSW
• Emily Lynn Kuehnl, RBT
• Katelyn Laaksonen
• Bryce Edward Labatte

• All providers in Providence, UT
• Clinical Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.