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NPI Code Detail

MEDICARE: JESSICA MARIE SERDAR LCSW

MEDICARE: JESSICA MARIE SERDAR LCSW
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 : 1336799923
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MARIE SERDAR LCSW
Provider Business Mailing Address
First Line : 750 N FREEDOM BLVD
Second Line :
City : PROVO
State : UT
Zip : 84601-1677
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5455 RIVER RUN DR
Second Line :
City : PROVO
State : UT
Zip : 84604-7726
Country : US
Telephone Number : 801-226-2550
Fax Number : 801-226-8298
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2019
Last Update Date : 10/11/2022

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Directions to “ JESSICA MARIE SERDAR LCSW” Practice Location

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