Provider Demographics
NPI:1235417684
Name:ALZHEIMERS DISEASE AND RELATED DISORDERS ASSOCIATION UTAH CHAPTER
Entity Type:Organization
Organization Name:ALZHEIMERS DISEASE AND RELATED DISORDERS ASSOCIATION UTAH CHAPTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNISHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-347-0074
Mailing Address - Street 1:855 E 4800 S STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5513
Mailing Address - Country:US
Mailing Address - Phone:801-265-1944
Mailing Address - Fax:
Practice Address - Street 1:855 E 4800 S STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-5513
Practice Address - Country:US
Practice Address - Phone:801-265-1944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0008208103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty