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Organization
PEDIATRIC BEHAVIORAL HEALTH
Active
Organization
PEDIATRIC BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD B CLARK MD (CHAIRPERSON)
(801) 587-7400
Entity
Organization
Contact information
Practice address
100 N MEDICAL DR, PEDS BEHAVIORAL HEALTH, SALT LAKE CITY, UT 84113-1103
(801) 662-2100
(801) 587-7741
Mailing address
295 CHIPETA WAY, U OF U SOM DEPT OF PEDIATRICS, SALT LAKE CITY, UT 84108-1220
(801) 587-7400
(801) 587-7417
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
—
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
—
—
Other
Enumeration date
05/03/2008
Last updated
09/06/2011
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