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NPI Code Detail

MEDICARE: KRISTINE GAIL OLSON BEELEK

MEDICARE: KRISTINE GAIL OLSON BEELEK
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
1106H00000XMarriage & Family Therapist329189-3902UT

General Provider Information

NPI Number : 1629549217
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINE GAIL OLSON BEELEK
Provider Business Mailing Address
First Line : 1381 E LANTERN LN
Second Line :
City : DRAPER
State : UT
Zip : 84020-5643
Country : US
Telephone Number : 801-712-6768
Fax Number :
Provider Business Practice Location Address
First Line : 4505 S WASATCH BLVD STE 290
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-4204
Country : US
Telephone Number : 385-695-5949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2018
Last Update Date : 12/08/2018

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Directions to “ KRISTINE GAIL OLSON BEELEK ” Practice Location

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