Healthcare Provider Details

I. General information

NPI: 1730330853
Provider Name (Legal Business Name): KRISTIN ELEANOR KASERMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N HARRISVILLE RD
HARRISVILLE UT
84404
US

IV. Provider business mailing address

5697 MAPLEWOOD DR
SOUTH OGDEN UT
84405-4850
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-1818
  • Fax:
Mailing address:
  • Phone: 505-385-0559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number9330898-3902
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0103331
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: