Provider Demographics
NPI:1306542204
Name:REDD-RECKSIEK, CAROLYNN (MFT)
Entity type:Individual
Prefix:
First Name:CAROLYNN
Middle Name:
Last Name:REDD-RECKSIEK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16261 S COUPLER LN
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-1872
Mailing Address - Country:US
Mailing Address - Phone:801-949-2357
Mailing Address - Fax:
Practice Address - Street 1:4625 S 2300 E STE 210
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4582
Practice Address - Country:US
Practice Address - Phone:801-865-1453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist