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General NPI Number Information
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NPI Number | 1598303596
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Entity Type | Individual
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Provider Name | KENYATTA GREEN CSW
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Gender | Male
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Dates
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Enumeration Date | 12/20/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 377 MARSHALL WAY STE 1
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City | LAYTON
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State | UT
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Zip | 84041-7378
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Country | US
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Telephone | 801-430-1280
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Fax | 801-747-6860
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Provider Business Mailing Address
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Address Line | 377 MARSHALL WAY STE 1
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City | LAYTON
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State | UT
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Zip | 84041-7378
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Country | US
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Telephone | 801-430-1280
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Fax | 801-747-6860
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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 |
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License Number State |
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