Provider Demographics
NPI:1619249240
Name:ANDERSON, KRISTEN ANN (CSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:ANN
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:271 E 1500 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7648
Mailing Address - Country:US
Mailing Address - Phone:801-205-0558
Mailing Address - Fax:
Practice Address - Street 1:7601 REDWOOD RD
Practice Address - Street 2:#E
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-4007
Practice Address - Country:US
Practice Address - Phone:801-233-8670
Practice Address - Fax:801-233-8682
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7736471-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker