Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 5080319-2501 | UT |
NPI | 1114336617 |
---|---|
Provider Name | Dr. Karen Checketts |
First Address | Sandy, UT 84070-5601 |
Second Address | Sandy, UT 84094-3132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2014 |
Last Update Date | 08/08/2014 |