Provider Demographics
NPI:1265106207
Name:RANKIN, LAUREN (PHD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:RANKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MEDICAL DR STE D101
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8905
Mailing Address - Country:US
Mailing Address - Phone:385-299-5683
Mailing Address - Fax:
Practice Address - Street 1:370 E SOUTH TEMPLE STE 175
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1241
Practice Address - Country:US
Practice Address - Phone:385-299-5683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13654457-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist