Provider Demographics
NPI:1316211683
Name:HANSEN, KEVIN TAYLOR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:TAYLOR
Last Name:HANSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1225 E FORT UNION BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1889
Mailing Address - Country:US
Mailing Address - Phone:801-233-2300
Mailing Address - Fax:
Practice Address - Street 1:1225 E FORT UNION BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84047-1889
Practice Address - Country:US
Practice Address - Phone:801-233-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7459168-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical