Healthcare Provider Details

I. General information

NPI: 1891225785
Provider Name (Legal Business Name): KASSIDY CAMPBELL MAHOSKEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5677 S 1475 E STE 4A
SOUTH OGDEN UT
84403-7003
US

IV. Provider business mailing address

PO BOX 9519
OGDEN UT
84409-0519
US

V. Phone/Fax

Practice location:
  • Phone: 385-222-3737
  • Fax:
Mailing address:
  • Phone: 801-689-1626
  • Fax: 801-475-7322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9413924-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9413924-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: