Provider Demographics
NPI:1992437768
Name:DONAT, KRISTIANE MADSEN
Entity type:Individual
Prefix:
First Name:KRISTIANE
Middle Name:MADSEN
Last Name:DONAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 N HILL FIELD RD STE 121
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-6958
Mailing Address - Country:US
Mailing Address - Phone:801-896-3376
Mailing Address - Fax:
Practice Address - Street 1:2363 N HILL FIELD RD STE 121
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041
Practice Address - Country:US
Practice Address - Phone:801-896-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7787806-3904106H00000X
UT7787806-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTHT008911-001OtherUHIN