Provider Demographics
NPI:1528089711
Name:KILPATRICK, LORRAINE S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:S
Last Name:KILPATRICK
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 1:6925 UNION PARK CTR
Mailing Address - Street 2:SUITE 490
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4142
Mailing Address - Country:US
Mailing Address - Phone:801-566-2622
Mailing Address - Fax:801-566-0536
Practice Address - Street 1:6925 UNION PARK CTR
Practice Address - Street 2:SUITE 490
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-4142
Practice Address - Country:US
Practice Address - Phone:801-566-2622
Practice Address - Fax:801-566-0536
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT126297-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical