Provider Demographics
NPI:1881644821
Name:HAMILTON, KRISTEN KIMBERLY (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KIMBERLY
Last Name:HAMILTON
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 1:550 W 700 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2227
Mailing Address - Country:US
Mailing Address - Phone:801-537-7537
Mailing Address - Fax:801-363-3140
Practice Address - Street 1:550 W 700 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2227
Practice Address - Country:US
Practice Address - Phone:801-537-7537
Practice Address - Fax:801-363-3140
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5830783-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000062534Medicare PIN