Provider Demographics
NPI:1144782558
Name:ANDELIN, KATE KELLY HARLINE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:KELLY HARLINE
Last Name:ANDELIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:HARLINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:777 E SOUTH TEMPLE APT 10C
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1274
Mailing Address - Country:US
Mailing Address - Phone:801-900-1613
Mailing Address - Fax:
Practice Address - Street 1:1174 E GRAYSTONE WAY STE 3
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2671
Practice Address - Country:US
Practice Address - Phone:385-262-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9808123-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical