Active NPI
Kyle Hansen Goudie, LCSW
- Clinical Social Worker
- Draper, UT
National Provider Identifier
1295857266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6370645-3501
- Practice address
- 11451 S 700 E
Suite E
Draper, UT 84020-8204 - Phone
- (801) 330-6324
- Fax
- (801) 330-6324
- NPI assigned
- Apr 3, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6370645-3501 | UT | Primary |
Addresses
Primary practice location
11451 S 700 E
Suite E
Draper, UT 84020-8204
Mailing address
11451 S 700 E
Suite E
Draper, UT 84020-8204
Phone (801) 330-6324
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6370645-3501 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247529600000",
"number": "1295857266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11451 S 700 E",
"address_2": "SUITE E",
"city": "DRAPER",
"state": "UT",
"postal_code": "840208204",
"telephone_number": "801-330-6324",
"fax_number": "801-330-6324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11451 S 700 E",
"address_2": "SUITE E",
"city": "DRAPER",
"state": "UT",
"postal_code": "840208204",
"telephone_number": "801-330-6324",
"fax_number": "801-330-6324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOUDIE",
"first_name": "KYLE",
"middle_name": "HANSEN",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-03",
"last_updated": "2009-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "6370645-3501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.