Provider Demographics
NPI:1366905556
Name:KIDD, KILEY MCCALL (CSW)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:MCCALL
Last Name:KIDD
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 1:1733 W 550 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1514
Mailing Address - Country:US
Mailing Address - Phone:559-679-1617
Mailing Address - Fax:
Practice Address - Street 1:719 N 1890 W # 38B
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1333
Practice Address - Country:US
Practice Address - Phone:559-679-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10187476-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker