Healthcare Provider Details

I. General information

NPI: 1497323786
Provider Name (Legal Business Name): KRISTIN WU CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2972 W MAPLE LOOP DR STE 101
LEHI UT
84043-5967
US

IV. Provider business mailing address

172 E 2000 N
OREM UT
84057-2299
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5450
  • Fax: 385-225-9327
Mailing address:
  • Phone: 541-778-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12224275-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: