Healthcare Provider Details

I. General information

NPI: 1669770343
Provider Name (Legal Business Name): JENNIFER MICHELLE MOLENI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BENGAL BLVD # H340
COTTONWOOD HEIGHTS UT
84121-7135
US

IV. Provider business mailing address

6069 W HAVEN RIDGE WAY
WEST VALLEY CITY UT
84128-5639
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-7277
  • Fax:
Mailing address:
  • Phone: 815-298-0425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number77532093503
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7753209-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: