Provider Demographics
NPI:1952812414
Name:WEITZMAN, LAUREN MICHELE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MICHELE
Last Name:WEITZMAN
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 1:579 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3234
Mailing Address - Country:US
Mailing Address - Phone:801-680-2941
Mailing Address - Fax:
Practice Address - Street 1:24 S 1100 E STE 303
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-4307
Practice Address - Country:US
Practice Address - Phone:801-680-2941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT287222-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist