Healthcare Provider Details

I. General information

NPI: 1497663629
Provider Name (Legal Business Name): KIMBERLEE ANN GREENBURG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W BROADWAY
SALT LAKE CITY UT
84101-2002
US

IV. Provider business mailing address

1497 W 220 N
PLEASANT GROVE UT
84062-3380
US

V. Phone/Fax

Practice location:
  • Phone: 801-380-5592
  • Fax:
Mailing address:
  • Phone: 801-380-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: