Healthcare Provider Details

I. General information

NPI: 1902141435
Provider Name (Legal Business Name): KRISTIN ELIZABETH STANLEY MSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 N 200 E
PROVO UT
84606-1705
US

IV. Provider business mailing address

750 N 200 E
PROVO UT
84606-1705
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-4760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14280402-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: