Healthcare Provider Details

I. General information

NPI: 1083486054
Provider Name (Legal Business Name): MRS. LAUREN KITCHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LAUREN WELLS

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 S 700 E STE 150
MURRAY UT
84107-8317
US

IV. Provider business mailing address

4516 S 700 E STE 150
MURRAY UT
84107-8317
US

V. Phone/Fax

Practice location:
  • Phone: 801-882-7149
  • Fax: 801-889-2725
Mailing address:
  • Phone: 801-882-7149
  • Fax: 801-889-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14168183-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: