Provider Demographics
NPI:1265982904
Name:BARTON, KELLY ANNE (MSW, MPH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:BARTON
Suffix:
Gender:F
Credentials:MSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:37624 SE FURY ST STE 101
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9680
Practice Address - Country:US
Practice Address - Phone:425-888-2016
Practice Address - Fax:206-320-5170
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60706472104100000X, 1041C0700X
ORL69181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker