Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 5624434-3501 | UT |
NPI | 1003161738 |
---|---|
Provider Name | Ms. Kristin Allison Midyett |
First Address | Slc, UT 84108-1222 |
Second Address | Slc, UT 84108-1222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2012 |
Last Update Date | 18/07/2012 |