Individual
MR. EVAN T KENISON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
100 S 1000 W, TOOELE, UT 84074-4010
(435) 843-3520
(435) 843-3555
Mailing address
PO BOX 751, TOOELE, UT 84074-0751
(435) 850-2547
(435) 843-7438
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3099283501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107029553101
INTRMTN. HEALTH CARE
UT
01
—
832612
DESERET MUTUAL
UT
01
—
942938348
CHAMPUS
UT
01
—
942938348EVK
EDUCATORS MUTUAL
UT
Enumeration date
01/25/2006
Last updated
08/08/2019
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