Provider Demographics
NPI:1497726186
Name:KADERA, SCOTT W (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:KADERA
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 1:635 DOWNINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3020
Mailing Address - Country:US
Mailing Address - Phone:801-323-0625
Mailing Address - Fax:
Practice Address - Street 1:4460 S. HIGHLAND DR, SUITE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-273-1085
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4827325-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4827325-2501OtherSTATE PSYCH LICENSE
UT4827325-2501OtherSTATE PSYCH LICENSE