Provider Demographics
NPI:1255646410
Name:KIMBALL, SARA TEMPEST (CSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:TEMPEST
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:TEEWINOT
Other - Last Name:KIMBALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:195 W 7200 S
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-3703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:195 W 7200 S
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-3703
Practice Address - Country:US
Practice Address - Phone:801-565-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7722227-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker