Provider Demographics
NPI:1184830705
Name:SCHWAB, KENNETH PUGMIRE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PUGMIRE
Last Name:SCHWAB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 500 S
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-3873
Mailing Address - Country:US
Mailing Address - Phone:801-910-1000
Mailing Address - Fax:801-292-8803
Practice Address - Street 1:535 E 500 S
Practice Address - Street 2:SUITE 5
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-3873
Practice Address - Country:US
Practice Address - Phone:801-910-1000
Practice Address - Fax:801-292-8803
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116694-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist