Healthcare Provider Details

I. General information

NPI: 1023269214
Provider Name (Legal Business Name): KENDRA L STIGGINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E 8400 S
SANDY UT
84070-0525
US

IV. Provider business mailing address

9164 SILVER LAKE DR
CEDAR HILLS UT
84062-8787
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-2556
  • Fax:
Mailing address:
  • Phone: 801-921-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number100629
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7061731-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: