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General NPI Number Information
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NPI Number | 1417235284
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Entity Type | Organization
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Legal Business Name | CHERYL KELSTROM-SMITH LCSW, LLC
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Dates
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Enumeration Date | 07/28/2011
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Last Update Date | 08/12/2011
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Provider Practice Location Address
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Address Line | 5149 S 1500 W
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City | RIVERDALE
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State | UT
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Zip | 84405-3926
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Country | US
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Telephone | 801-475-0402
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Fax | 801-475-7464
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Provider Business Mailing Address
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Address Line | PO BOX 213
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City | ROY
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State | UT
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Zip | 84067-0213
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Country | US
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Telephone | 801-475-0402
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Fax | 801-475-7464
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | MS. CHERYL KELSTROM-SMITH
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Credential | LCSW
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Telephone | 801-475-0402
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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 | 4730671-3501
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License Number State | UT
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