Healthcare Provider Details

I. General information

NPI: 1235666405
Provider Name (Legal Business Name): COLLEEN DORIS KLEINBERG PELLETTE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN DORIS KLEINBERG MSW

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 S 450 E
HEBER CITY UT
84032-4800
US

IV. Provider business mailing address

2360 S 450 E
HEBER CITY UT
84032-4800
US

V. Phone/Fax

Practice location:
  • Phone: 484-225-0617
  • Fax:
Mailing address:
  • Phone: 484-225-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW68862
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020178
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13269672-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: