Healthcare Provider Details

I. General information

NPI: 1972263614
Provider Name (Legal Business Name): JACQUELINE LOUISE LOVELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 S 2300 E STE 211
HOLLADAY UT
84117-4582
US

IV. Provider business mailing address

8920 S QUAIL RUN DR
SANDY UT
84093-1710
US

V. Phone/Fax

Practice location:
  • Phone: 801-865-1453
  • Fax:
Mailing address:
  • Phone: 801-875-8980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8898999-3501
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: