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NPI Code Detail

MEDICARE: JESSICA LYNN CLAWSON CSWI

MEDICARE: JESSICA LYNN CLAWSON CSWI
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 Worker12829259-3506UT

General Provider Information

NPI Number : 1801526264
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LYNN CLAWSON CSWI
Provider Business Mailing Address
First Line : 2150 S MAIN ST STE 219
Second Line :
City : SOUTH SALT LAKE
State : UT
Zip : 84115-2664
Country : US
Telephone Number : 208-681-3878
Fax Number :
Provider Business Practice Location Address
First Line : 1570 S 1100 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84105-2441
Country : US
Telephone Number : 801-528-9077
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2022
Last Update Date : 07/18/2022

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