Healthcare Provider Details

I. General information

NPI: 1982527180
Provider Name (Legal Business Name): MRS. JESSICA NANETTE MORAN X
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 LINCOLN AVE
OGDEN UT
84404-5638
US

IV. Provider business mailing address

788 CHESTER LN
KAYSVILLE UT
84037-4166
US

V. Phone/Fax

Practice location:
  • Phone: 801-621-6510
  • Fax:
Mailing address:
  • Phone: 385-439-5411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: