Organization
CHERYL KELSTROM-SMITH LCSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHERYL KELSTROM-SMITH LCSW (PROVIDER/OWNER)
(801) 475-0402
Entity
Organization
Contact information
Practice address
5149 S 1500 W, RIVERDALE, UT 84405-3926
(801) 475-0402
(801) 475-7464
Mailing address
PO BOX 213, ROY, UT 84067-0213
(801) 475-0402
(801) 475-7464
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4730671-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12/19/1949
BIRTHDAY
UT
01
—
SKYLER
DOG
UT
Enumeration date
07/28/2011
Last updated
08/12/2011
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