KELLY KONOPACKI (NPI# 1912362591) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1912362591 |
Entity Type | Individual |
Full Name | KELLY KONOPACKI |
Credential | PHD |
Practice Address |
501 Chipeta Way Salt Lake City UT 84108 |
Mailing Address |
501 S Chipeta Way Salt Lake City UT 84108-1222 |
Practice Telephone | 8015873143 |
Mailing Telephone | 6507395434 |
Enumeration Date | 2015-12-23 |
Last Update Date | 2018-07-18 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 103G00000X | Clinical Neuropsychologist | 10299168-2501 | UT | Behavioral Health & Social Service Providers |
Street Address |
501 CHIPETA WAY |
City | SALT LAKE CITY |
State | UT |
Zip Code | 84108 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1245220805 | Robert D Birch | Psychiatry & Neurology | 501 Chipeta Way, Suite 1214, Salt Lake City, UT 84108-0108 | 2005-10-25 |
1093327140 | Joshua Morris | Psychologist | 501 Chipeta Way, Salt Lake City, UT 84108 | 2020-08-19 |
1073141925 | Rachel Niezrecki | Student in an Organized Health Care Education/Training Program | 501 Chipeta Way, Salt Lake City, UT 84108 | 2020-03-27 |
1831621333 | Heiko Weert De Riese | Psychiatry & Neurology | 501 Chipeta Way, Rm. 1885, Salt Lake City, UT 84108 | 2017-04-03 |
1174978811 | Brittany Mccolgan | Psychiatry & Neurology | 501 Chipeta Way, University of Utah Psychiatry Department, Salt Lake City, UT 84108 | 2016-05-02 |
1912388463 | Alison Lafollette | Psychologist | 501 Chipeta Way, Salt Lake City, UT 84108-1222 | 2015-06-10 |
1366829004 | Sean Patrick Ferrell | Psychiatry & Neurology | 501 Chipeta Way, Salt Lake City, UT 84108 | 2015-05-01 |
1932471471 | Robert D Birch Do PC | Psychiatry & Neurology | 501 Chipeta Way, Suite 1214, Salt Lake City, UT 84108-1222 | 2012-01-30 |
1487922670 | Laurian Escalanti | Social Worker | 501 Chipeta Way, University Neuropsychiatric Institute, Salt Lake City, UT 84108-1222 | 2011-12-02 |
1184918609 | Jennifer Rounds | Social Worker | 501 Chipeta Way, Salt Lake City, UT 84108 | 2011-06-01 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1548753056 | Maxine Ht Erickson | Assistant Behavior Analyst | 780 Guardsman Way, Salt Lake City, Ut 84108, Salt Lake City, USA 84108 | 2018-06-08 |
1841704061 | Robyn Carver | Occupational Therapist | 421 Wakara Wat, Salt Lake City, UT 84108 | 2017-11-27 |
1518478742 | Lcr Dental Sugar House | Dentist | 2068 S 2100 E Suite #a, Salt Lake City, UT 84108 | 2017-10-16 |
1447708912 | Aubrianne Squire Evans | Occupational Therapist | 421 S Wakara Way Ste 201, Salt Lake City, UT 84108 | 2016-09-14 |
1629524426 | Ryan Weisenbeck | Specialist/Technologist | 580 S Guardsman Way, Salt Lake City, UT 84108 | 2016-08-31 |
1164885547 | Michael Fazzone | Student in an Organized Health Care Education/Training Program | 530 South Wakara Way, University of Urah, School of Dentistry, Salt Lake City, UT 84108 | 2016-04-01 |
1669833489 | Bryon Claflin | Registered Nurse | 650 S Komas Ste 200, Salt Lake City, UT 84108 | 2016-03-08 |
1801283833 | Autism Assement Treatment Program Adult | Psychologist | 650 S Komas, Suite 200, Salt Lake City, UT 84108 | 2015-04-16 |
1578993275 | Matthew and David Dental Pllc | Dentist | 1355 Foothill Drive, Salt Lake City, UT 84108 | 2013-11-15 |
1841631520 | Deepika Garg | Internal Medicine | 675 S Arapeen Dr Ste 205, Salt Lake City, UT 84108 | 2013-07-10 |
Find all providers in zip 84108 |
Taxonomy Code | 103G00000X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Clinical Neuropsychologist |
An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1770954356 | Erin Elizabeth Krauskopf | Clinical Neuropsychologist | 231 E 400 S Ste 335, Salt Lake City, UT 84111-2806 | 2015-10-08 |
1528469947 | Jordan Harris Rigby | Clinical Neuropsychologist | 230 S 500 E Ste 100, Salt Lake City, UT 84102-2048 | 2014-09-05 |
1154565729 | Keith Mcgoldrick | Clinical Neuropsychologist | 1733 S 1100 E Ste 102, Salt Lake City, UT 84105-3482 | 2009-04-27 |
1356593297 | Dustin Bradshaw Hammers | Clinical Neuropsychologist | 650 Komas Dr Ste 106a, Salt Lake City, UT 84108-1225 | 2008-10-22 |
1770612863 | Elaine Clark | Clinical Neuropsychologist | 501 Chipita Way, Univ of Utah Neuropsychiatric Institute, Salt Lake City, UT 84108 | 2007-03-05 |
1245251776 | Kelly D Garrett | Clinical Neuropsychologist | 333 South 900 East, Salt Lake City, UT 84102-2310 | 2006-07-21 |
1831150374 | Juan A. Mejia | Clinical Neuropsychologist | 327 Denver St, Salt Lake City, UT 84111-3002 | 2006-03-31 |
1295720969 | Kevin Duff | Clinical Neuropsychologist | 650 Komas Dr, 106a, Salt Lake City, UT 84108-1215 | 2005-09-19 |
1518453406 | Joseph Un Kim | Clinical Neuropsychologist | 501 S Chipeta Way, Salt Lake City, UT 84108-1222 | 2018-07-03 |
1922394220 | Jeremy J Davis | Clinical Neuropsychologist | 30 N 1900 E, 1r55, Salt Lake City, UT 84132-0002 | 2011-06-24 |
Find all providers in SALT LAKE CITY |
City | SALT LAKE CITY |
Zip Code | 84108 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.