Individual
JON LEROY PERTAB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
5171 SOUTH COTTONWOOD ST SUITE 810, NEUROSCIENCES INSTITUTE,, MURRAY, UT 84107
(801) 507-9800
(801) 507-9800
Mailing address
5171 SOUTH COTTONWOOD ST SUITE 810, NEUROSCIENCES INSTITUTE,, MURRAY, UT 84107
(801) 507-9800
(801) 507-9800
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
7759498-2501
UT
103T00000X
Psychologist
Primary
7759498-2501
UT
103TC0700X
Clinical Psychologist
7759498-2501
UT
103TH0004X
Health Psychologist
7759498-2501
UT
Other
Enumeration date
11/22/2010
Last updated
05/10/2013
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