Provider Demographics
NPI:1982038238
Name:PENNY BROOKE JAMESON, PH. D., P.C.
Entity Type:Organization
Organization Name:PENNY BROOKE JAMESON, PH. D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:JAMESON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD PSYCHOLOGY
Authorized Official - Phone:801-350-0118
Mailing Address - Street 1:1801 S 2600 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3331
Mailing Address - Country:US
Mailing Address - Phone:801-350-0118
Mailing Address - Fax:
Practice Address - Street 1:1801 S 2600 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-3331
Practice Address - Country:US
Practice Address - Phone:801-350-0118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT277000-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000007588Medicare UPIN