Provider Demographics
NPI:1073083929
Name:RITH, KENDRICK A (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENDRICK
Middle Name:A
Last Name:RITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10432 S 4000 W STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5729
Mailing Address - Country:US
Mailing Address - Phone:801-923-2253
Mailing Address - Fax:385-247-5088
Practice Address - Street 1:10432 S 4000 W STE B
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5729
Practice Address - Country:US
Practice Address - Phone:801-923-2253
Practice Address - Fax:385-247-5088
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10499907-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT3009694Medicaid