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NPI Code Detail

MEDICARE: JAIMEE L CHARLESWORTH BS, CSW

MEDICARE: JAIMEE L CHARLESWORTH BS, CSW
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
1104100000XSocial Worker14015801-3502

General Provider Information

NPI Number : 1609477819
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIMEE L CHARLESWORTH BS, CSW
Provider Business Mailing Address
First Line : 1965 HERITAGE PKWY
Second Line :
City : SYRACUSE
State : UT
Zip : 84075-7063
Country : US
Telephone Number : 801-628-0414
Fax Number : 801-683-8962
Provider Business Practice Location Address
First Line : 172 N EAST PROMONTORY STE 270
Second Line :
City : FARMINGTON
State : UT
Zip : 84025-2964
Country : US
Telephone Number : 801-940-5184
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2020
Last Update Date : 08/07/2025

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