Healthcare Provider Details

I. General information

NPI: 1982172839
Provider Name (Legal Business Name): JESSICA MICHELLE VAN NATTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 E 820 N
OREM UT
84097-5481
US

IV. Provider business mailing address

857 E 200 S
SALT LAKE CITY UT
84102-2317
US

V. Phone/Fax

Practice location:
  • Phone: 801-960-2560
  • Fax:
Mailing address:
  • Phone: 801-487-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6075422-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

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: