Provider Demographics
NPI:1265842579
Name:COOLIDGE, ELYSE FRANCES (MD)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:FRANCES
Last Name:COOLIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:COOLIDGE
Other - Last Name:HUEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2666 S 2000 E STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1721
Mailing Address - Country:US
Mailing Address - Phone:801-864-4077
Mailing Address - Fax:
Practice Address - Street 1:2666 S 2000 E STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1721
Practice Address - Country:US
Practice Address - Phone:801-864-4077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11320286-12052084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry