Provider Demographics
NPI:1497844955
Name:HODSON, KRISTIN B (CSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:B
Last Name:HODSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 PARK MANOR DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4226
Mailing Address - Country:US
Mailing Address - Phone:801-808-0636
Mailing Address - Fax:
Practice Address - Street 1:1670 E. 1300 E.
Practice Address - Street 2:SUITE 204
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84105
Practice Address - Country:US
Practice Address - Phone:801-808-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6217132-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical