Brandi Kolditz, CSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12358022-3506 Issued in UT

Practice address

4460 S Highland Dr
Salt Lake City, UT 84124-3543

Phone

(801) 263-7100

NPI assigned

Jul 15, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Brandi Jackson Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Papilion Integrated Recovery Centers

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Orem, UT
  • NPI 1023474509
  NPD (past)

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

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679011200000",
    "number": "1376927830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1537 N 3890 W",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840436900",
            "telephone_number": "435-327-1776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4460 S HIGHLAND DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841243543",
            "telephone_number": "801-263-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLDITZ",
        "first_name": "BRANDI",
        "credential": "CSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-15",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "12358022-3506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING",
            "identifier": "12358022-3502",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376927830",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Slack.com",
            "affiliation": "Y",
            "affiliationName": "Valley Behavioral Health LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Service Coordination",
            "address_1": "4460 S Highland Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841243543",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Microsoft",
            "affiliation": "Y",
            "affiliationName": "Valley Behavioral Health LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "4460 S Highland Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841243543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "BRANDI",
            "last_name": "JACKSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rawia Koko
• Kristine Kokol, LCSW
• Vinodhini Kolandavelu, PA-C
• Kaydence Kolba
• Jana Kolc, M.D.
• Mitchell R. Koles, PH.D.
• Kolff Dialysis Center University of Utah
• Robin Elizabeth Kolff, PT
• Caroline Susan Koli
• Naa Koli

• Clinical Social Worker in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; 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.