Provider Demographics
NPI:1053133884
Name:COLLOPY, ALEX (PHD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:COLLOPY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:ROSENWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 E 4TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3268
Mailing Address - Country:US
Mailing Address - Phone:267-614-8190
Mailing Address - Fax:
Practice Address - Street 1:424 E 4TH AVE APT 4
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3268
Practice Address - Country:US
Practice Address - Phone:267-614-8190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program