Provider Demographics
NPI:1437677457
Name:OBERG, KAITIN LEE
Entity type:Individual
Prefix:
First Name:KAITIN
Middle Name:LEE
Last Name:OBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 E STRINGHAM AVE APT 202B
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-3911
Mailing Address - Country:US
Mailing Address - Phone:801-361-3195
Mailing Address - Fax:
Practice Address - Street 1:857 E 200 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2317
Practice Address - Country:US
Practice Address - Phone:801-487-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool