Provider Demographics
NPI:1588720932
Name:PAGE, KIMBERLY ANN (CSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:PAGE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5191 W 4525 S
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:UT
Mailing Address - Zip Code:84315-9696
Mailing Address - Country:US
Mailing Address - Phone:801-497-0204
Mailing Address - Fax:
Practice Address - Street 1:836 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-7117
Practice Address - Country:US
Practice Address - Phone:801-497-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT529398035021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical