Healthcare Provider Details

I. General information

NPI: 1982901005
Provider Name (Legal Business Name): KRISTI VERSTEEG CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 S REDWOOD RD BUILDING E
WEST JORDAN UT
84084-4007
US

IV. Provider business mailing address

7601 S REDWOOD RD BUILDING E
WEST JORDAN UT
84084-4007
US

V. Phone/Fax

Practice location:
  • Phone: 801-696-2177
  • Fax: 801-233-8682
Mailing address:
  • Phone: 801-696-2177
  • Fax: 801-233-8682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number74657426005
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: