Healthcare Provider Details

I. General information

NPI: 1700734498
Provider Name (Legal Business Name): JEFFERSON WOLFRAM TURNER CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18406 W WHITE QUEST DR
EAGLE MOUNTAIN UT
84013-9701
US

IV. Provider business mailing address

7400 S STATE ST APT 2203
MIDVALE UT
84047-6109
US

V. Phone/Fax

Practice location:
  • Phone: 801-335-4699
  • Fax:
Mailing address:
  • Phone: 915-304-9921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number142369133502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: