Kevin Michael Fenstermacher, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

5075655-2501 Issued in UT

Practice address

1549 E 3970 S
Millcreek, UT 84124-1524

Phone

(801) 201-3139

NPI assigned

Jan 30, 2019

Last updated

Jan 30, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fenster Corp.

  • Clinical Child & Adolescent Psychologist
  • Salt Lake City, UT
  • NPI 1265592083
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548806400000",
    "number": "1083178404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1549 E 3970 S",
            "city": "MILLCREEK",
            "state": "UT",
            "postal_code": "841241524",
            "telephone_number": "801-201-3139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1549 E 3970 S",
            "city": "MILLCREEK",
            "state": "UT",
            "postal_code": "841241524",
            "telephone_number": "801-201-3139"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4505 S Wasatch Blvd Ste 380",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841244733",
            "country_code": "US",
            "telephone_number": "801-201-3139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FENSTERMACHER",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-01-30",
        "last_updated": "2019-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "UT",
            "license": "5075655-2501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Evans, CSW
• Ever Better Health PC
• Julie Fakih
• Jennifer Lynn Falkner, DNP
• Far Sky Healing
• Corinna Fitzwater, CMHC
• Sean Michael Forster, ACMHC
• Gary Wayne Foss, LMT
• Abigail Fraley
• Weston Fredman, CSW, CASUDC

• Psychologist in Millcreek, UT
• Providers in Millcreek, UT by specialty
• Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.