MEDICARE: KWINTEN KEMP

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	101YP2500X	Professional Counselor	5641837-6004	UT

General Provider Information

NPI Number	:	1689858631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KWINTEN KEMP

Provider Business Mailing Address
First Line	:	2760 RASMUSSEN RD
Second Line	:	BUILDING D, SUITE 205
City	:	PARK CITY
State	:	UT
Zip	:	84098-5684
Country	:	US
Telephone Number	:	435-608-1417
Fax Number	:	435-487-9107

Provider Business Practice Location Address
First Line	:	2760 RASMUSSEN RD
Second Line	:	BUILDING D, SUITE 205
City	:	PARK CITY
State	:	UT
Zip	:	84098-5684
Country	:	US
Telephone Number	:	435-608-1417
Fax Number	:	435-487-9107

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	08/31/2010

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Directions to “ KWINTEN KEMP ” Practice Location

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