Provider Demographics
NPI:1093397036
Name:KIRTLEY, NATALIE (PHD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:KIRTLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 W 880 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-8446
Mailing Address - Country:US
Mailing Address - Phone:801-362-0155
Mailing Address - Fax:
Practice Address - Street 1:380 E MAIN ST BLDG B2ND
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:UT
Practice Address - Zip Code:84049-6801
Practice Address - Country:US
Practice Address - Phone:435-633-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10244471-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist