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NPI Code Detail

MEDICARE: KINDRA GAYLE SEALY BEAN LCSW

MEDICARE: KINDRA GAYLE SEALY BEAN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041S0200XSchool Social Worker
21041C0700XClinical Social Worker8595126-3501UT

General Provider Information

NPI Number : 1447506639
Entity Type Code : Individual
Provider Name (Legal Business Name) : KINDRA GAYLE SEALY BEAN LCSW
Provider Business Mailing Address
First Line : 1082 E 100 S
Second Line :
City : LOGAN
State : UT
Zip : 84321-4973
Country : US
Telephone Number : 435-994-0754
Fax Number :
Provider Business Practice Location Address
First Line : 1525 N 200 W
Second Line :
City : LOGAN
State : UT
Zip : 84341-2032
Country : US
Telephone Number : 435-752-8880
Fax Number : 435-752-8884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2012
Last Update Date : 10/19/2018

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Directions to “ KINDRA GAYLE SEALY BEAN LCSW” Practice Location

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