Individual
KELLY GODECKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
501 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(406) 925-2712
Mailing address
501 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(406) 925-2712
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
10093895-8905
UT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/16/2015
Last updated
11/02/2021
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