Provider Demographics
NPI:1407898059
Name:VANUITERT, DENNIS (PHD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:VANUITERT
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-387-5600
Mailing Address - Fax:801-475-4720
Practice Address - Street 1:5030 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4311
Practice Address - Country:US
Practice Address - Phone:801-387-5600
Practice Address - Fax:801-475-4720
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113359-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR92070Medicare UPIN
000060412Medicare PIN
000059143Medicare PIN
UT000063574Medicare PIN
000060264Medicare PIN
005522054Medicare PIN
000059142Medicare PIN
006902014Medicare PIN