Individual
MR. DAVID COOP KOLDEWYN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
195 W 7200 S, MIDVALE, UT 84047-3703
(801) 565-6900
Mailing address
1802 OMNI AVE, SALT LAKE CITY, UT 84116-4600
(801) 322-3136
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2948753501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107001586101
INTERMOUNTAIN HEALTH CARE
UT
01
—
311135
DESERET MUTUAL
UT
01
—
942938348K01
EDUCATORS MUTUAL
UT
Enumeration date
01/09/2006
Last updated
07/08/2007
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