Provider Demographics
NPI:1427567817
Name:PIRSIG, STEPHANIE JO (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JO
Last Name:PIRSIG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 E 4065 S
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1452
Mailing Address - Country:US
Mailing Address - Phone:507-320-2133
Mailing Address - Fax:
Practice Address - Street 1:170 S 1000 E STE 201
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1403
Practice Address - Country:US
Practice Address - Phone:801-419-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
UT1297886202501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12978862-2501OtherUTAH STATE PSYCHOLOGIST LICENSE