| Doctor Name: | DR. KAYLEEN M FULLER |
| NPI Number: | 1073552402 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 200419-2501 |
| Business Practice Address: | 5200 South Highland Drive Suite 202 Holladay, UT - 84117 |
| Business Phone Number: | 8016522720 |
| Business Fax Number: | 8012776003 |
| Mailing Address: | Po Box 902380, SANDY |
| State: | UT |
| Postal Code: | 840902380 |
| Phone Number: | 8016522720 |
| Fax Number: | 8012776003 |
| NPI Enumeration Date: | 06/04/2006 |
| NPI Last Update Date: | 03/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 200419-2501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |