Healthcare Provider Details

I. General information

NPI: 1093500191
Provider Name (Legal Business Name): JILL EDMUNDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 E 4800 S STE 250
MURRAY UT
84107-5519
US

IV. Provider business mailing address

1275 E 530 N
OREM UT
84097-5439
US

V. Phone/Fax

Practice location:
  • Phone: 801-882-7149
  • Fax:
Mailing address:
  • Phone: 801-380-5268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: