Healthcare Provider Details

I. General information

NPI: 1821729450
Provider Name (Legal Business Name): LINDSEY ANNE JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5137 S 1500 W
RIVERDALE UT
84405-3926
US

IV. Provider business mailing address

2062 W 850 N
LAYTON UT
84041-7578
US

V. Phone/Fax

Practice location:
  • Phone: 801-540-3021
  • Fax:
Mailing address:
  • Phone: 801-540-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14133361-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: