Provider Demographics
NPI:1871291989
Name:LOPEZ, KASSIDY RAE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KASSIDY
Middle Name:RAE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KASSIDY
Other - Middle Name:RAE
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1208 E 3300 S
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2522
Mailing Address - Country:US
Mailing Address - Phone:801-483-1600
Mailing Address - Fax:801-483-1610
Practice Address - Street 1:1208 E 3300 S
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84106-2522
Practice Address - Country:US
Practice Address - Phone:801-483-1600
Practice Address - Fax:801-483-1610
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1224706535011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical