=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629197447
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELSEY K. BARRUS CSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 07/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 W MAIN ST
-----------------------------------------------------
City | LEHI
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84043-2146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-528-3247
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7746 RUSTIC PINE CV
-----------------------------------------------------
City | MIDVALE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84047-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-380-8823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 7087087-3502
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------