MEDICARE: KAYLA DUNCAN

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	12957421-3501	UT

General Provider Information

NPI Number	:	1114426962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA DUNCAN

Provider Business Mailing Address
First Line	:	5373 W LAKE PARK BLVD
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-8208
Country	:	US
Telephone Number	:	801-902-8080
Fax Number	:	919-882-8348

Provider Business Practice Location Address
First Line	:	5373 W LAKE PARK BLVD
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-8208
Country	:	US
Telephone Number	:	385-622-0316
Fax Number	:

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

Provider Enumeration Date	:	02/07/2018
Last Update Date	:	05/02/2024

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