Healthcare Provider Details

I. General information

NPI: 1316873045
Provider Name (Legal Business Name): KIMBERLY PACE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4933 S 1500 W STE 200
RIVERDALE UT
84405-7738
US

IV. Provider business mailing address

92 RANCH RD
FARMINGTON UT
84025-2651
US

V. Phone/Fax

Practice location:
  • Phone: 801-698-9881
  • Fax:
Mailing address:
  • Phone: 801-698-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13970998-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: