Active NPI
Kaylee Del Rudd, MFT
- Marriage & Family Therapist
- South Jordan, UT
National Provider Identifier
1831805662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 12488619-3904
- Practice address
- 3674 W South Jordan Pkwy
South Jordan, UT 84009-7159 - Phone
- (801) 349-9606
- NPI assigned
- Jan 25, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 12488619-3904 | UT | Primary |
Addresses
Primary practice location
3674 W South Jordan Pkwy
South Jordan, UT 84009-7159
Mailing address
945 W Zaffre Hills LN
Bluffdale, UT 84065-2004
Phone (208) 891-3038
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 17, 2024 through Jan 17, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12488619-3904 | UT | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674604800000",
"number": "1831805662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "945 W ZAFFRE HILLS LN",
"city": "BLUFFDALE",
"state": "UT",
"postal_code": "840652004",
"telephone_number": "208-891-3038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3674 W SOUTH JORDAN PKWY",
"city": "SOUTH JORDAN",
"state": "UT",
"postal_code": "840097159",
"telephone_number": "801-349-9606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDD",
"first_name": "KAYLEE",
"middle_name": "DEL",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-01-25",
"last_updated": "2023-01-25",
"certification_date": "2023-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "UT",
"license": "12488619-3904",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Jordan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.