Healthcare Provider Details

I. General information

NPI: 1023997277
Provider Name (Legal Business Name): KATELIN WOOD CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 N 400 E
LOGAN UT
84341-2321
US

IV. Provider business mailing address

180 S MAIN ST
SMITHFIELD UT
84335-1910
US

V. Phone/Fax

Practice location:
  • Phone: 801-871-5118
  • Fax:
Mailing address:
  • Phone: 402-320-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14240281-3502
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: