Provider Demographics
NPI:1316658446
Name:BARTON, KELLYN LACEY (LSW, CSW)
Entity type:Individual
Prefix:MS
First Name:KELLYN
Middle Name:LACEY
Last Name:BARTON
Suffix:
Gender:F
Credentials:LSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5549 W BLUEVAIL CT
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5226
Mailing Address - Country:US
Mailing Address - Phone:717-798-7117
Mailing Address - Fax:
Practice Address - Street 1:563 W 500 S STE 220
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8289
Practice Address - Country:US
Practice Address - Phone:717-790-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13683024-35021041C0700X
PASW1393071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical