Provider Demographics
NPI:1851409049
Name:CAMERON, JOANNE BROWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:BROWN
Last Name:CAMERON
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 1:4505 SOUTH WAGATCH BLVD
Mailing Address - Street 2:STE 381
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-277-7543
Mailing Address - Fax:
Practice Address - Street 1:4505 SOUTH WAGATCH BLVD
Practice Address - Street 2:STE 381
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-277-7543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1144222501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist