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General NPI Number Information
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NPI Number | 1689464844
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Entity Type | Individual
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Provider Name | ALEXIS KENISON CSW
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Gender | Female
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Dates
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Enumeration Date | 05/10/2025
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Last Update Date | 05/10/2025
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Provider Practice Location Address
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Address Line | 2297 N HILL FIELD RD STE 103
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City | LAYTON
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State | UT
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Zip | 84041-6927
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Country | US
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Telephone | 385-888-9040
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Fax |
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Provider Business Mailing Address
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Address Line | 821 W 1875 N
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City | CLINTON
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State | UT
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Zip | 84015-8712
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13391976-3502
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License Number State | UT
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