Provider Demographics
NPI:1730301474
Name:O'CONNOR, BEVERLY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:
Last Name:O'CONNOR
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 1:533 26TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2465
Mailing Address - Country:US
Mailing Address - Phone:801-621-7320
Mailing Address - Fax:801-394-0394
Practice Address - Street 1:533 26TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2465
Practice Address - Country:US
Practice Address - Phone:801-621-7320
Practice Address - Fax:801-394-0394
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT191411-2501103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist