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NPI Code Detail

MEDICARE: MS. KENDELL B RAAT LCSW

MEDICARE: MS. KENDELL B RAAT 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
11041C0700XClinical Social Worker266241-3501UT

General Provider Information

NPI Number : 1679551956
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KENDELL B RAAT LCSW
Provider Business Mailing Address
First Line : 1727 APACHE WAY
Second Line :
City : OGDEN
State : UT
Zip : 84403-4459
Country : US
Telephone Number : 801-479-3234
Fax Number :
Provider Business Practice Location Address
First Line : 237 26TH ST
Second Line :
City : OGDEN
State : UT
Zip : 84401-3105
Country : US
Telephone Number : 801-625-3811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 07/08/2007

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