Healthcare Provider Details

I. General information

NPI: 1639843576
Provider Name (Legal Business Name): IRENE JONES CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 S 200 W STE 1
BLANDING UT
84511-3923
US

IV. Provider business mailing address

735 S 200 W STE 1
BLANDING UT
84511-3923
US

V. Phone/Fax

Practice location:
  • Phone: 435-678-2992
  • Fax: 435-678-3116
Mailing address:
  • Phone: 435-678-2992
  • Fax: 435-678-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12381913-3506
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: