Individual
KIMBERLY MITCHELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
780 GUARDSMAN WAY, SALT LAKE CITY, UT 84108-1374
(801) 581-0194
(801) 581-0193
Mailing address
14106 CANDY PULL DR, DRAPER, UT 84020-7513
(801) 577-2712
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4912299-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107035680101
INTERMTN. HEALTH CARE
UT
01
—
907899
DESERET MUTUAL
UT
Enumeration date
01/20/2006
Last updated
07/08/2007
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