Basic Information
| Provider Information | |||||||||
| NPI: | 1508203480 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNTINGTON | ||||||||
| FirstName: | KILEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 172 W CLINTON AVE APT 102 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841031812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015873359 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 650 S KOMAS DR | ||||||||
| Address2: | #200 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841081215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015873359 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2013 | ||||||||
| LastUpdateDate: | 05/31/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.