Provider Demographics
NPI:1427668722
Name:RILEY, KATRINA MARISOL (LCSW)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARISOL
Last Name:RILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6170 W DEER SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:KEARNS
Mailing Address - State:UT
Mailing Address - Zip Code:84118-9301
Mailing Address - Country:US
Mailing Address - Phone:385-227-3528
Mailing Address - Fax:
Practice Address - Street 1:3336 S PIONEER PKWY STE 201
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2085
Practice Address - Country:US
Practice Address - Phone:801-313-0555
Practice Address - Fax:801-313-9669
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10371566-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical