| Cheryl Kelstrom-smith Lcsw, Llc | |
|
5149 S 1500 W Riverdale UT 84405-3926 | |
| (801) 475-0402 | |
| (801) 475-7464 |
| Full Name | Cheryl Kelstrom-smith Lcsw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5149 S 1500 W, Riverdale, Utah |
| Authorized Official Name and Position | Cheryl Kelstrom-smith (PROVIDER/OWNER) |
| Authorized Official Contact | 8014750402 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cheryl Kelstrom-smith Lcsw, Llc Po Box 213 Roy UT 84067-0213 Ph: (801) 475-0402 | Cheryl Kelstrom-smith Lcsw, Llc 5149 S 1500 W Riverdale UT 84405-3926 Ph: (801) 475-0402 |
| NPI Number | 1417235284 |
|---|---|
| Provider Enumeration Date | 07/28/2011 |
| Last Update Date | 08/12/2011 |
| Medicare PECOS PAC ID | 5395915466 |
|---|---|
| Medicare Enrollment ID | O20110827000009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417235284 | NPI | - | NPPES |
| 12/19/1949 | Other | UT | BIRTHDAY |
| SKYLER | Other | UT | DOG |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 4730671-3501 (Utah) | Primary |
| Provider Name | Cheryl Kelstrom-smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740335850 PECOS PAC ID: 0042117020 Enrollment ID: I20031217000775 |
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