Provider Demographics
NPI:1154847259
Name:SAGERS, KIMBERLY NOELLE PELLEGRINI
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NOELLE PELLEGRINI
Last Name:SAGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:NOELLE
Other - Last Name:PELLEGRINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9008 N FOREST LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8013
Mailing Address - Country:US
Mailing Address - Phone:801-931-9639
Mailing Address - Fax:
Practice Address - Street 1:6770 S 900 E STE 201
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5548
Practice Address - Country:US
Practice Address - Phone:801-305-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11316233-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical