Healthcare Provider Details

I. General information

NPI: 1629984257
Provider Name (Legal Business Name): JADE CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 S COMMERCE DR STE E130
MURRAY UT
84107-5330
US

IV. Provider business mailing address

88 S 900 E STE 208
SALT LAKE CITY UT
84102-1896
US

V. Phone/Fax

Practice location:
  • Phone: 801-810-7730
  • Fax:
Mailing address:
  • Phone: 435-224-3878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14135357-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: