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General NPI Number Information
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NPI Number | 1992699110
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Entity Type | Individual
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Provider Name | KATHRYN GRAHAM
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Gender |
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 2655 S LAKE ERIE DR
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City | WEST VALLEY CITY
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State | UT
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Zip | 84120-7350
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Country | US
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Telephone | 385-441-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 3785 S ALTA LOMA DR
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City | MILLCREEK
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State | UT
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Zip | 84106-2901
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Country | US
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Telephone | 801-554-4136
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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 | 14224180-3502
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License Number State | UT
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