Healthcare Provider Details

I. General information

NPI: 1710769674
Provider Name (Legal Business Name): JORDAN ADAM ZABRISKIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date: 10/23/2023
Reactivation Date: 07/23/2025

III. Provider practice location address

825 N 1420 E
OREM UT
84097-5484
US

IV. Provider business mailing address

825 N 1420 E
OREM UT
84097-5484
US

V. Phone/Fax

Practice location:
  • Phone: 801-425-2150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9665936-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: