Healthcare Provider Details

I. General information

NPI: 1124495577
Provider Name (Legal Business Name): KIMBERLY VANSWEDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 GARLAND WAY
HILL AFB UT
84056-5700
US

IV. Provider business mailing address

7525 GARLAND WAY BLDG 928
HILL AFB UT
84056-5700
US

V. Phone/Fax

Practice location:
  • Phone: 801-777-3075
  • Fax:
Mailing address:
  • Phone: 801-777-3075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10199528-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: