Provider Demographics
NPI:1851921381
Name:WINGARD, KATHRYN (LCMHC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:WINGARD
Suffix:
Gender:F
Credentials:LCMHC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5622 S WALDEN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-7925
Mailing Address - Country:US
Mailing Address - Phone:385-346-0031
Mailing Address - Fax:
Practice Address - Street 1:940 E SOUTH UNION AVE
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2302
Practice Address - Country:US
Practice Address - Phone:385-346-0031
Practice Address - Fax:385-446-0973
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17-277221700000X
UT10178806-6004101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty