Provider Demographics
NPI:1891754628
Name:JAGIELLO-CALDWELL, KORINA MAGDALENA (CPCI)
Entity Type:Individual
Prefix:MRS
First Name:KORINA
Middle Name:MAGDALENA
Last Name:JAGIELLO-CALDWELL
Suffix:
Gender:F
Credentials:CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 W 4700 S
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-2156
Mailing Address - Country:US
Mailing Address - Phone:801-964-2465
Mailing Address - Fax:
Practice Address - Street 1:2880 W 4700 S
Practice Address - Street 2:SUITE 1A
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-2156
Practice Address - Country:US
Practice Address - Phone:801-964-2465
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4929649-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health