Provider Demographics
NPI:1780858662
Name:TAVERNE, ANNE F (PHD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:F
Last Name:TAVERNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5242 SO. 4820 W.
Mailing Address - Street 2:THE CHILDREN'S CENTER
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84118-6422
Mailing Address - Country:US
Mailing Address - Phone:801-966-4251
Mailing Address - Fax:
Practice Address - Street 1:5242 SO. 4820 W.
Practice Address - Street 2:THE CHILDREN'S CENTER
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84118-6422
Practice Address - Country:US
Practice Address - Phone:801-966-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT363423-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1780858662OtherNPI