Provider Demographics
NPI:1467073577
Name:UNDEMIR, FILIZ (LSW)
Entity Type:Individual
Prefix:
First Name:FILIZ
Middle Name:
Last Name:UNDEMIR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:FILIZ
Other - Middle Name:
Other - Last Name:KREISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4479 S 1965 W UNIT 40
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-2799
Mailing Address - Country:US
Mailing Address - Phone:646-552-6620
Mailing Address - Fax:
Practice Address - Street 1:2200 S STATE ST FL 2
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2724
Practice Address - Country:US
Practice Address - Phone:801-359-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11748832-3502104100000X
NJ44SL06243600104100000X
UT11748832-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker