Kevin Michael Fenstermacher, PHD
Individual provider Active NPI Psychologist · Millcreek, UT
NPI 1083178404 · NPPES record last updated Jan 30, 2019
Key facts
- NPI
- 1083178404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 5075655-2501 (UT)
- Practice address
- 1549 E 3970 S
Millcreek, UT 84124-1524 - Phone
- (801) 201-3139
- NPI assigned
- Jan 30, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5075655-2501 | UT | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fenster Corp. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 5075655-2501 | UT | Yes |
Addresses
Primary practice location
1549 E 3970 S
Millcreek, UT 84124-1524
Mailing address
1549 E 3970 S
Millcreek, UT 84124-1524
Phone (801) 201-3139
Other practice location 1
4505 S Wasatch Blvd Ste 380
Salt Lake City, UT 84124-4733
Phone (801) 201-3139
Other providers in Millcreek, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.