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General NPI Number Information
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NPI Number | 1578870747
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Entity Type | Individual
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Provider Name | KRISTINA RAE MCDOUGAL LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 1140 36TH ST
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City | OGDEN
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State | UT
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Zip | 84403-2050
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Country | US
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Telephone | 801-631-2380
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Fax |
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Provider Business Mailing Address
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Address Line | 3055 W 4450 S
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City | ROY
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State | UT
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Zip | 84067-9559
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Country | US
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Telephone | 801-631-2380
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7711976-3502
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License Number State | UT
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