Healthcare Provider Details

I. General information

NPI: 1154847259
Provider Name (Legal Business Name): KIMBERLY NOELLE PELLEGRINI SAGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY NOELLE PELLEGRINI

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 S 900 E STE 201
MIDVALE UT
84047-5548
US

IV. Provider business mailing address

9008 N FOREST LAKE CIR
CEDAR HILLS UT
84062-8013
US

V. Phone/Fax

Practice location:
  • Phone: 801-305-3171
  • Fax:
Mailing address:
  • Phone: 801-931-9639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11316233-3502
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: