MEDICARE: KIMBERLY SCARLET JONES C-SUD-C

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1205714250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SCARLET JONES C-SUD-C

Provider Business Mailing Address
First Line	:	2145 W 13480 S
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-5758
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8420 S WASATCH BLVD
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-6043
Country	:	US
Telephone Number	:	801-901-0024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2025
Last Update Date	:	08/26/2025

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Directions to “ KIMBERLY SCARLET JONES C-SUD-C” Practice Location

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