Provider Demographics
NPI:1194704692
Name:HUNT, LORI KETTLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:KETTLE
Last Name:HUNT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:KETTLE
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1966 E RUA BRANCO DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6907
Mailing Address - Country:US
Mailing Address - Phone:801-916-0863
Mailing Address - Fax:
Practice Address - Street 1:9361 S 300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2902
Practice Address - Country:US
Practice Address - Phone:801-826-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT532692935011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT53269293500001OtherBLUE CROSS
UTUOO6107030524101Medicare UPIN
UT53269293500001OtherBLUE CROSS
UTUOO2885234Medicare UPIN