Provider Demographics
NPI:1275351751
Name:DEAN, KATIE (CSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MASOB
Mailing Address - Street 2:195 N 1950 W
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116
Mailing Address - Country:US
Mailing Address - Phone:801-447-8027
Mailing Address - Fax:
Practice Address - Street 1:MASOB
Practice Address - Street 2:195 N 1950 W
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116
Practice Address - Country:US
Practice Address - Phone:801-447-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1102238235021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical