Healthcare Provider Details

I. General information

NPI: 1245277052
Provider Name (Legal Business Name): KATHLEEN MARCIE REMINGTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BITTER BRUSH LANE
BLUFFDALE UT
84020
US

IV. Provider business mailing address

11456 SOUTH COPPER STONE DR
SOUTH JORDAN UT
84095
US

V. Phone/Fax

Practice location:
  • Phone: 801-576-7000
  • Fax:
Mailing address:
  • Phone: 801-253-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2743953501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: