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NPI Code Detail

MEDICARE: MRS. KRISTIE MARIE CHRISTOFFERSON LCSW

MEDICARE: MRS. KRISTIE MARIE CHRISTOFFERSON 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
11041C0700XClinical Social Worker51906463501UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1107035230101OTHERUTINTRMTN. HEALTH CARE
2885123OTHERUTDESERET MUTUAL

General Provider Information

NPI Number : 1578541330
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTIE MARIE CHRISTOFFERSON LCSW
Provider Business Mailing Address
First Line : 6856 S 700 E
Second Line :
City : MIDVALE
State : UT
Zip : 84047-1361
Country : US
Telephone Number : 801-743-6100
Fax Number :
Provider Business Practice Location Address
First Line : 6856 S 700 E
Second Line :
City : MIDVALE
State : UT
Zip : 84047-1361
Country : US
Telephone Number : 801-743-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 07/08/2007

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