Provider Demographics
NPI:1306167044
Name:HORMAN, KRISTA LEA (MSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LEA
Last Name:HORMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3986
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3986
Mailing Address - Country:US
Mailing Address - Phone:801-971-8373
Mailing Address - Fax:
Practice Address - Street 1:1140 36TH ST STE 285
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2064
Practice Address - Country:US
Practice Address - Phone:801-971-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5192232-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker