Individual
MS. SUSAN KIMBALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
280 M ST, SALT LAKE CITY, UT 84103-3548
(801) 359-4229
Mailing address
280 M ST, SALT LAKE CITY, UT 84103-3548
(801) 359-4229
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
56777276005
UT
Other
Enumeration date
06/10/2010
Last updated
06/10/2010
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