Healthcare Provider Details

I. General information

NPI: 1578433694
Provider Name (Legal Business Name): JAMIE LEE CRENSHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N HARRISVILLE RD
HARRISVILLE UT
84404-3537
US

IV. Provider business mailing address

3939 ORCHARD AVE
SOUTH OGDEN UT
84403-1809
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-1818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14240204-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: