Basic Information
| Provider Information | |||||||||
| NPI: | 1730330853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KASERMAN | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | ELEANOR | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5697 MAPLEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844054850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053850559 | ||||||||
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| Practice Location | |||||||||
| Address1: | 811 N HARRISVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HARRISVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013991818 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2008 | ||||||||
| LastUpdateDate: | 01/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 9330898-3902 | UT | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 0103331 | NM | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.