MEDICARE: JENNY ANN REARDON

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	1041C0700X	Clinical Social Worker	10382038-3501	UT

General Provider Information

NPI Number	:	1871958686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY ANN REARDON

Provider Business Mailing Address
First Line	:	3585 N UNIVERSITY AVE
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3585 N UNIVERSITY AVE
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6601
Country	:	US
Telephone Number	:	208-860-9370
Fax Number	:

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

Provider Enumeration Date	:	12/21/2015
Last Update Date	:	04/09/2025

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Directions to “ JENNY ANN REARDON ” Practice Location

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