Provider Demographics
NPI:1346608684
Name:ATKIN, CHANTELLE (CSW)
Entity type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:
Last Name:ATKIN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:CHANTELLE
Other - Middle Name:DAWN
Other - Last Name:IVIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:437 E 1000 S
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3623
Mailing Address - Country:US
Mailing Address - Phone:801-987-6335
Mailing Address - Fax:
Practice Address - Street 1:437 E 1000 S
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3623
Practice Address - Country:US
Practice Address - Phone:801-987-6335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9490505-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical