Provider Demographics
NPI:1598457608
Name:UNDERWOOD, KJARSTENA KEEPER
Entity type:Individual
Prefix:
First Name:KJARSTENA
Middle Name:KEEPER
Last Name:UNDERWOOD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N ROMNEY LN APT 201
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-6721
Mailing Address - Country:US
Mailing Address - Phone:385-222-8417
Mailing Address - Fax:
Practice Address - Street 1:155 N ROMNEY LN APT 201
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-6721
Practice Address - Country:US
Practice Address - Phone:385-222-8417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1-25-79678103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician