Gedge, Eliza Rachelle

Gedge, Eliza Rachelle is an individual health care provider with primary practice located at 750 N Freedom Blvd , Provo UT 84601-1677. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counseling, Behavioral Health & Social Service Providers / Clinical, Student, Health Care / Student in an Organized Health Care Education/Training Program. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Gedge, Eliza Rachelle can be contacted via phone (801) 373-0639.

Contact Information

Primary practice address
750 N Freedom Blvd Provo UT 84601-1677
Phone: (801) 373-0639
Fax: (801) 373-0639
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counseling 103TC1900X 6301014858 Michigan
Behavioral Health & Social Service Providers / Clinical 1041C0700X 12966150-2501 Utah
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Behavioral Health & Social Service Providers / Clinical 103TC0700X 12966150-25801 Utah

Profile Details

NPI number 1003197658
LBN Legal business name Gedge, Eliza Rachelle
Credentials PH.D., LP
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 8th, 2011
Last updated Apr 2nd, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003197658 NPPES
Michigan MEDICAID 1883825

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