Basic Information
| Provider Information | |||||||||
| NPI: | 1124313085 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADAM SCHWEBACH INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEUROPSYCHOLOGY CENTER OF UTAH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95970 | ||||||||
| Address2: | |||||||||
| City: | SOUTH JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840950970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006588556 | ||||||||
| FaxNumber: | 8013529502 | ||||||||
| Practice Location | |||||||||
| Address1: | 1477 N 2000 W | ||||||||
| Address2: | SUITE E | ||||||||
| City: | CLINTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840158638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016145866 | ||||||||
| FaxNumber: | 8018251162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2011 | ||||||||
| LastUpdateDate: | 06/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | SCHWEBACH | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8016145866 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 360871-2501 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
ID Information
| ID | Type | State | Issuer | Description | 1780837047 | 05 | UT | MEDICAID |