Provider Demographics
NPI:1538137328
Name:DODGION, DAVID A (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:DODGION
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 1:5691 S REDWOOD RD
Mailing Address - Street 2:SUITE #15
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5322
Mailing Address - Country:US
Mailing Address - Phone:801-281-4084
Mailing Address - Fax:801-281-4083
Practice Address - Street 1:5691 S REDWOOD RD
Practice Address - Street 2:SUITE #15
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5322
Practice Address - Country:US
Practice Address - Phone:801-281-4084
Practice Address - Fax:801-281-4083
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113751-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical