Active NPI
Mary Jann Dewitt, PHD
- Clinical Psychologist
- Salt Lake City, UT
National Provider Identifier
1730149295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 308921-2501
- Practice address
- 1104 E Ashton Ave Ste 108
Salt Lake City, UT 84106-2348 - Phone
- (801) 510-4547
- NPI assigned
- Mar 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 308921-2501 | UT | Primary |
Addresses
Primary practice location
1104 E Ashton Ave Ste 108
Salt Lake City, UT 84106-2348
Mailing address
22 W 1800 S
Bountiful, UT 84010-5243
Phone (801) 296-8408
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D1487 | Medicaid | UT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Primary Care Sports Med | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Sports Medicine (Family Medicine) Physician
- Salt Lake City, UT
- NPI 1699796706
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530921600000",
"number": "1730149295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 W 1800 S",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840105243",
"telephone_number": "801-296-8408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1104 E ASHTON AVE STE 108",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841062348",
"telephone_number": "801-510-4547"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWITT",
"first_name": "MARY",
"middle_name": "JANN",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-27",
"last_updated": "2018-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "UT",
"license": "308921-2501",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D1487",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.