Provider Demographics
NPI:1205509429
Name:SUORSA-JOHNSON, KRISTINA IRENE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:IRENE
Last Name:SUORSA-JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:IRENE
Other - Last Name:SUORSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:815 E ROWLEY DR
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3028
Mailing Address - Country:US
Mailing Address - Phone:401-864-5906
Mailing Address - Fax:
Practice Address - Street 1:81 N MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1125
Practice Address - Country:US
Practice Address - Phone:801-662-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12196719-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical