MEDICARE: MS. KATHLEEN ROSE REIMHERR 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	911375513501	UT

General Provider Information

NPI Number	:	1871564112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ROSE REIMHERR LCSW

Provider Business Mailing Address
First Line	:	1524 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2425
Country	:	US
Telephone Number	:	801-538-2057
Fax Number	:	801-596-2515

Provider Business Practice Location Address
First Line	:	1524 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2425
Country	:	US
Telephone Number	:	801-467-1200
Fax Number	:	801-467-1210

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	02/06/2012

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