Provider Demographics
NPI:1548752264
Name:KIMMERLY, NANCY (PHD, CSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:KIMMERLY
Suffix:
Gender:F
Credentials:PHD, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 S 700 E STE 9
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2581
Mailing Address - Country:US
Mailing Address - Phone:801-441-0816
Mailing Address - Fax:
Practice Address - Street 1:4000 S 700 E STE 9
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2581
Practice Address - Country:US
Practice Address - Phone:801-441-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT146975422OtherUTAH LICENSE