Adrienne Melissa Koffman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6625159-3506 Issued in UT

Practice address

4625 S 2300 E Ste 211
Holladay, UT 84117-4582

Phone

(801) 865-1453

NPI assigned

Jun 12, 2007

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

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.

• Millcreek Counseling & Adoption Services, Inc.

  • Clinical Social Worker
  • Holladay, UT
  • NPI 1235800210
  NPD (past)

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427328000000",
    "number": "1992909170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4052 S COMET CIR",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841241910",
            "telephone_number": "801-673-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4625 S 2300 E STE 211",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841174582",
            "telephone_number": "801-865-1453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOFFMAN",
        "first_name": "ADRIENNE",
        "middle_name": "MELISSA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-12",
        "last_updated": "2015-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "6625159-3506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Michael Kelly, DPT
• Jacob Kenison
• Kristina A. Kill, D.C.
• Kanon Knaphus, LMT
• Christy Kobe, LCSW
• Stacey Mills Lake, NP
• Ralph T Larsen, DDS
• Katia Lecuyer, LDEM, CPM
• Hayley Leishman, LCSW
• Shauna Ann Leonard, PA-C

• Clinical Social Worker in Holladay, UT
• Providers in Holladay, 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 26, 2015; 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.