Provider Demographics
NPI:1679826556
Name:DORN, UMA P (PHD)
Entity Type:Individual
Prefix:DR
First Name:UMA
Middle Name:P
Last Name:DORN
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 1:342 E TERRA SOL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5088
Mailing Address - Country:US
Mailing Address - Phone:404-488-6125
Mailing Address - Fax:
Practice Address - Street 1:850 E 300 S STE 6
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2332
Practice Address - Country:US
Practice Address - Phone:404-488-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist