Individual
KAITLYN JO THACKERAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSW, CPH
Contact information
Practice address
11260 S RIVER HEIGHTS DR, SOUTH JORDAN, UT 84095-5119
(801) 298-2000
Mailing address
4073 S ACORD WAY, WEST VALLEY CITY, UT 84120-4009
(385) 449-8536
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
12923253-3502
UT
Other
Enumeration date
07/27/2022
Last updated
07/27/2022
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