Provider Demographics
NPI:1649886920
Name:MASON, KATHERINE SUN AE (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUN AE
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATEY
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1354 E 3300 S STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3083
Mailing Address - Country:US
Mailing Address - Phone:801-265-8000
Mailing Address - Fax:801-265-8004
Practice Address - Street 1:1354 E 3300 S STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3083
Practice Address - Country:US
Practice Address - Phone:801-265-8000
Practice Address - Fax:801-265-8004
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8635806-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical