Provider Demographics
NPI:1770300055
Name:SANDS, KEVIN (SSW, MSWI)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:SANDS
Suffix:
Gender:M
Credentials:SSW, MSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 W AUTO MALL DR STE 4
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2200
Mailing Address - Country:US
Mailing Address - Phone:435-429-1269
Mailing Address - Fax:
Practice Address - Street 1:283 W AUTO MALL DR STE 4
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2200
Practice Address - Country:US
Practice Address - Phone:435-429-1269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13969847-3503171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator