Healthcare Provider Details

I. General information

NPI: 1063106862
Provider Name (Legal Business Name): JANA LEE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S FAIRFIELD RD STE A106
LAYTON UT
84041-7105
US

IV. Provider business mailing address

124 S FAIRFIELD RD STE A106
LAYTON UT
84041-7105
US

V. Phone/Fax

Practice location:
  • Phone: 801-874-3535
  • Fax: 888-830-7710
Mailing address:
  • Phone: 801-874-3535
  • Fax: 888-830-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14292151-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: