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General NPI Number Information
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NPI Number | 1447005665
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Entity Type | Individual
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Provider Name | KAYLA MARIE HERITAGE SSW
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Gender | Female
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 880 HERITAGE PARK BLVD STE 130
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City | LAYTON
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State | UT
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Zip | 84041-5674
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Country | US
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Telephone | 801-931-9980
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Fax |
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Provider Business Mailing Address
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Address Line | 1466 BANBURY DR
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City | SYRACUSE
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State | UT
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Zip | 84075-9487
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Country | US
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Telephone | 801-931-9989
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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