Healthcare Provider Details

I. General information

NPI: 1104765015
Provider Name (Legal Business Name): JESSIE WINTERBOTTOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 N HILL FIELD RD STE 103
LAYTON UT
84041-4782
US

IV. Provider business mailing address

2317 N HILL FIELD RD STE 103
LAYTON UT
84041-4782
US

V. Phone/Fax

Practice location:
  • Phone: 801-913-1212
  • Fax: 801-609-5751
Mailing address:
  • Phone: 801-913-1212
  • Fax: 801-609-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13370990-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: