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General NPI Number Information
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NPI Number | 1316658446
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Entity Type | Individual
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Provider Name | KELLYN LACEY BARTON LSW, CSW
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Gender | Female
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 563 W 500 S STE 220
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City | BOUNTIFUL
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State | UT
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Zip | 84010-8289
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Country | US
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Telephone | 717-790-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 5549 W BLUEVAIL CT
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City | WEST JORDAN
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State | UT
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Zip | 84081-5226
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Country | US
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Telephone | 717-798-7117
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13683024-3502
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW139307
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License Number State | PA
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