Provider Demographics
NPI:1497323786
Name:WU, KRISTIN (CSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 E 2000 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2299
Mailing Address - Country:US
Mailing Address - Phone:541-778-9197
Mailing Address - Fax:
Practice Address - Street 1:11038 HIGHLAND BLVD STE 300
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-3788
Practice Address - Country:US
Practice Address - Phone:801-655-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12224275-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker