1699750018 NPI number — DR. KIMBERLY RUTH WALSH PSY.D.

Table of content: DR. KIMBERLY RUTH WALSH PSY.D. (NPI 1699750018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699750018 NPI number — DR. KIMBERLY RUTH WALSH PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALSH
Provider First Name:
KIMBERLY
Provider Middle Name:
RUTH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699750018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 150214
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OGDEN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84415-0214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-690-0353
Provider Business Mailing Address Fax Number:
801-479-7020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1452 EAST RIDGELINE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 151
Provider Business Practice Location Address City Name:
SOUTH OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-690-0353
Provider Business Practice Location Address Fax Number:
801-479-7020
Provider Enumeration Date:
12/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  117391-2501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 117391-2501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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