Healthcare Provider Details

I. General information

NPI: 1568002772
Provider Name (Legal Business Name): JEANETTE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 11/27/2023
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 S 1600 W
MAPLETON UT
84664-4221
US

IV. Provider business mailing address

1308 S 1600 W
MAPLETON UT
84664-4221
US

V. Phone/Fax

Practice location:
  • Phone: 385-327-7334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number274405-3501
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: