Healthcare Provider Details

I. General information

NPI: 1225193998
Provider Name (Legal Business Name): JAN MARIE MALMBERG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2006
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 SOUTH STATE STREET SUITE A
MIDVALE UT
84047-6105
US

IV. Provider business mailing address

7321 SOUTH STATE STREET SUITE A
MIDVALE UT
84047-6105
US

V. Phone/Fax

Practice location:
  • Phone: 801-878-4327
  • Fax: 801-878-9280
Mailing address:
  • Phone: 801-878-4327
  • Fax: 801-878-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4905206-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: