Individual
HEATHER BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
500 FOOTHILL DR, SALT LAKE CITY, UT 84148-0001
(801) 852-1565
Mailing address
500 FOOTHILL DR, SALT LAKE CITY, UT 84148-0001
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
9247682-2501
UT
Other
Enumeration date
04/06/2015
Last updated
04/06/2015
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