Healthcare Provider Details

I. General information

NPI: 1528089711
Provider Name (Legal Business Name): LORRAINE S KILPATRICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6925 UNION PARK CTR SUITE 490
MIDVALE UT
84047-4142
US

IV. Provider business mailing address

6925 UNION PARK CTR SUITE 490
MIDVALE UT
84047-4142
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-2622
  • Fax: 801-566-0536
Mailing address:
  • Phone: 801-566-2622
  • Fax: 801-566-0536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126297-3501
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: