Healthcare Provider Details

I. General information

NPI: 1679199889
Provider Name (Legal Business Name): KALEE MARIE GROSS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 S 1000 E STE 201
SALT LAKE CITY UT
84102-1403
US

IV. Provider business mailing address

170 S 1000 E STE 201
SALT LAKE CITY UT
84102-1403
US

V. Phone/Fax

Practice location:
  • Phone: 801-419-0139
  • Fax:
Mailing address:
  • Phone: 801-419-0139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number12345275-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: