Healthcare Provider Details

I. General information

NPI: 1851921381
Provider Name (Legal Business Name): KATHRYN WINGARD LCMHC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 05/22/2023
Certification Date: 05/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 E SOUTH UNION AVE
MIDVALE UT
84047-2302
US

IV. Provider business mailing address

5622 S WALDEN GLEN DR
SALT LAKE CITY UT
84123-7925
US

V. Phone/Fax

Practice location:
  • Phone: 385-346-0031
  • Fax: 385-446-0973
Mailing address:
  • Phone: 385-346-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10178806-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number17-277
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: