MEDICARE: KIMI L ENDTER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	7026701-3501	UT

General Provider Information

NPI Number	:	1083070437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMI L ENDTER LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1190
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84771-1190
Country	:	US
Telephone Number	:	435-319-0039
Fax Number	:

Provider Business Practice Location Address
First Line	:	437 S BLUFF ST STE 302
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84770-3591
Country	:	US
Telephone Number	:	435-634-8848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2016
Last Update Date	:	04/17/2024

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