Healthcare Provider Details

I. General information

NPI: 1770439150
Provider Name (Legal Business Name): ANDREA JOLYNNE JEPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 W 1800 N STE A
CLINTON UT
84015-8503
US

IV. Provider business mailing address

11895 W 10400 N
TREMONTON UT
84337-6742
US

V. Phone/Fax

Practice location:
  • Phone: 801-217-3133
  • Fax: 801-528-5067
Mailing address:
  • Phone: 801-217-3133
  • Fax: 801-528-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12435863-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: