Provider Demographics
NPI:1508084781
Name:OSWALD, KYLE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:OSWALD
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E SOUTH TEMPLE
Mailing Address - Street 2:JSMB 1L
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84150-0491
Mailing Address - Country:US
Mailing Address - Phone:801-240-0910
Mailing Address - Fax:
Practice Address - Street 1:15 E SOUTH TEMPLE
Practice Address - Street 2:JSMB 1L
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84150-0491
Practice Address - Country:US
Practice Address - Phone:801-240-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4763766-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical