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NPI Code Detail

MEDICARE: JESSICA SHIPLEY MSW

MEDICARE: JESSICA SHIPLEY MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1194347088
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SHIPLEY MSW
Provider Business Mailing Address
First Line : 10329 S SANDY WILLOWS CV
Second Line :
City : SANDY
State : UT
Zip : 84070-4325
Country : US
Telephone Number : 310-469-2420
Fax Number :
Provider Business Practice Location Address
First Line : 1525 N 200 W
Second Line :
City : LOGAN
State : UT
Zip : 84341-2032
Country : US
Telephone Number : 435-752-8880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2020
Last Update Date : 05/13/2020

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