Provider Demographics
NPI:1164692323
Name:BINGHAM, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 N 2000 W STE 1
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-8059
Mailing Address - Country:US
Mailing Address - Phone:801-452-7752
Mailing Address - Fax:801-773-7060
Practice Address - Street 1:1812 N 2000 W STE 1
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-8059
Practice Address - Country:US
Practice Address - Phone:801-452-7752
Practice Address - Fax:801-773-7060
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7181523-3502101YP2500X
UT7181523-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional