Provider Demographics
NPI:1144824962
Name:YOAKUM, KELSEY ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANNE
Last Name:YOAKUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 I ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3139
Mailing Address - Country:US
Mailing Address - Phone:385-707-5296
Mailing Address - Fax:
Practice Address - Street 1:735 E 9000 S STE 100
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3089
Practice Address - Country:US
Practice Address - Phone:385-706-5296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12326593-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical