Provider Demographics
NPI:1821273772
Name:DANSIE, KIRK R (PSYD, MSCP)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:R
Last Name:DANSIE
Suffix:
Gender:M
Credentials:PSYD, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 PIONEER ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-3048
Mailing Address - Country:US
Mailing Address - Phone:801-484-6892
Mailing Address - Fax:
Practice Address - Street 1:3370 PIONEER ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-3048
Practice Address - Country:US
Practice Address - Phone:801-484-6892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5412520-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical