Provider Demographics
NPI:1407227259
Name:FRANDSEN, KELLI
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:FRANDSEN
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 1:517 W ASPEN PEAK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4128
Mailing Address - Country:US
Mailing Address - Phone:801-505-1867
Mailing Address - Fax:
Practice Address - Street 1:11075 S STATE ST STE 30
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5129
Practice Address - Country:US
Practice Address - Phone:801-350-1671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7734679-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker