Provider Demographics
NPI:1336665264
Name:TAGGART, KYLE S (CSW)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:S
Last Name:TAGGART
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 W 1900 S STE 140
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9643
Mailing Address - Country:US
Mailing Address - Phone:801-809-3398
Mailing Address - Fax:
Practice Address - Street 1:2019 W 1900 S STE 140
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9643
Practice Address - Country:US
Practice Address - Phone:801-809-3398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10832956-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical