Provider Demographics
NPI:1952553794
Name:TROTTER, VINESSA KAYE (PHD)
Entity type:Individual
Prefix:
First Name:VINESSA
Middle Name:KAYE
Last Name:TROTTER
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 1:14425 S BITTERBRUSH LN
Mailing Address - Street 2:P.O. BOX 250
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9501
Mailing Address - Country:US
Mailing Address - Phone:801-576-7250
Mailing Address - Fax:801-576-7268
Practice Address - Street 1:14425 S BITTERBRUSH LN
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9501
Practice Address - Country:US
Practice Address - Phone:801-576-7250
Practice Address - Fax:801-576-7268
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7083777-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
U000073243OtherMEDICARE PTAN