OrganizationActive
Pediatric Behavioral Health
NPI 1942476569 · Developmental - Behavioral Pediatrics Physician · Salt Lake City, UT
Provider details
- NPI number
- 1942476569
- Entity type
- Organization
- Primary specialty
- Developmental - Behavioral Pediatrics PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Edward Clark, Chairperson(801) 587-7400
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Pediatrics Physician208000000X
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
100 N Medical Dr
Peds Behavioral Health
Salt Lake City, UT 84113-1103
Phone: (801) 662-2100
Fax: (801) 587-7741
Approximate (ZIP-level) locationGet directions
Mailing address
295 Chipeta Way
Salt Lake City, UT 84108-1220
Registry dates
- Enumerated
- 2008-05-03
- Last updated
- 2011-09-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.