Healthcare Provider Details

I. General information

NPI: 1881031771
Provider Name (Legal Business Name): JENESS L WOODARD L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W UNIVERSITY PKWY
OREM UT
84058-7316
US

IV. Provider business mailing address

145 W UNIVERSITY PKWY
OREM UT
84058-7316
US

V. Phone/Fax

Practice location:
  • Phone: 801-234-8600
  • Fax:
Mailing address:
  • Phone: 801-234-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number79455973501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: