Individual
KAELEA ROSE WAGAMAN-HASSELSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ALSUDC
Contact information
Practice address
950 E 3300 S, SALT LAKE CITY, UT 84106-2141
(801) 359-8862
Mailing address
716 N 900 W APT 106, SALT LAKE CITY, UT 84116-4014
(425) 374-9449
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12592546-6008
UT
Other
Enumeration date
01/13/2022
Last updated
01/13/2022
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