Individual
DR. DEBRA MARIE QUACKENBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1399 S 700 E, SALT LAKE CITY, UT 84105-2160
(801) 832-1050
Mailing address
2259 WELLINGTON ST, SALT LAKE CITY, UT 84106-4118
(801) 322-2876
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
334840-2501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1070011059101
I H C
UT
01
—
740411
DESERET MUTUAL
UT
01
—
942938348QU1
EDUCATOR'S MUTUAL
UT
Enumeration date
01/03/2006
Last updated
08/17/2007
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