Healthcare Provider Details

I. General information

NPI: 1467361170
Provider Name (Legal Business Name): KASSIE MARY BUTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 S LAKE ERIE DR STE B
WEST VALLEY CITY UT
84120-7351
US

IV. Provider business mailing address

10578 S CANYON VILLA DR
SANDY UT
84092-4636
US

V. Phone/Fax

Practice location:
  • Phone: 385-441-4900
  • Fax:
Mailing address:
  • Phone: 801-556-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: