Healthcare Provider Details

I. General information

NPI: 1144666132
Provider Name (Legal Business Name): KARINA C PENROD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 E PAGES LN STE A
CENTERVILLE UT
84014-2216
US

IV. Provider business mailing address

1355 N MAIN ST STE 1
BOUNTIFUL UT
84010-5982
US

V. Phone/Fax

Practice location:
  • Phone: 801-294-0578
  • Fax: 801-298-2147
Mailing address:
  • Phone: 801-259-3883
  • Fax: 801-295-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9046927-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: