Provider Demographics
NPI:1629429717
Name:STOSICH, KAREE
Entity Type:Individual
Prefix:
First Name:KAREE
Middle Name:
Last Name:STOSICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3166 W 9340 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8766
Mailing Address - Country:US
Mailing Address - Phone:801-864-0374
Mailing Address - Fax:
Practice Address - Street 1:3166 W 9340 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8766
Practice Address - Country:US
Practice Address - Phone:801-864-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist