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NPI Code Detail

MEDICARE: KIMBERLY MITCHELL LCSW

MEDICARE: KIMBERLY MITCHELL 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 Worker4912299-3501UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1107035680101OTHERUTINTERMTN. HEALTH CARE
2907899OTHERUTDESERET MUTUAL

General Provider Information

NPI Number : 1861472177
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY MITCHELL LCSW
Provider Business Mailing Address
First Line : 14106 CANDY PULL DR
Second Line :
City : DRAPER
State : UT
Zip : 84020-7513
Country : US
Telephone Number : 801-577-2712
Fax Number :
Provider Business Practice Location Address
First Line : 780 GUARDSMAN WAY
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1374
Country : US
Telephone Number : 801-581-0194
Fax Number : 801-581-0193
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2006
Last Update Date : 07/08/2007

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Directions to “ KIMBERLY MITCHELL LCSW” Practice Location

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