Provider Demographics
NPI:1760229603
Name:PHIPPS, KRISTEN LOUISE (LAC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LOUISE
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 E WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3324
Mailing Address - Country:US
Mailing Address - Phone:801-550-1725
Mailing Address - Fax:
Practice Address - Street 1:1390 S 1100 E STE 110
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2463
Practice Address - Country:US
Practice Address - Phone:801-707-7612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5500557-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist