1184048043 NPI number — KATHLEEN FITZWILLIAM LAKEY LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184048043 NPI number — KATHLEEN FITZWILLIAM LAKEY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAKEY
Provider First Name:
KATHLEEN
Provider Middle Name:
FITZWILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FITZWILLIAM
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184048043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 E SOUTH TEMPLE
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84111-1247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
385-218-8266
Provider Business Mailing Address Fax Number:
801-364-1433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 E SOUTH TEMPLE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84111-1247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-218-8266
Provider Business Practice Location Address Fax Number:
801-364-1433
Provider Enumeration Date:
02/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  7698951-3501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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