Provider Demographics
NPI:1578541330
Name:CHRISTOFFERSON, KRISTIE MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:MARIE
Last Name:CHRISTOFFERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6856 S 700 E
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1361
Mailing Address - Country:US
Mailing Address - Phone:801-743-6100
Mailing Address - Fax:
Practice Address - Street 1:6856 S 700 E
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1361
Practice Address - Country:US
Practice Address - Phone:801-743-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT519064635011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107035230101OtherINTRMTN. HEALTH CARE
UT885123OtherDESERET MUTUAL