Healthcare Provider Details

I. General information

NPI: 1932397312
Provider Name (Legal Business Name): JENNIFER T JOLLEY SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N STATE ST
SALINA UT
84654-1363
US

IV. Provider business mailing address

45 N STATE ST
SALINA UT
84654-1363
US

V. Phone/Fax

Practice location:
  • Phone: 435-529-2234
  • Fax: 435-529-2236
Mailing address:
  • Phone: 435-529-2234
  • Fax: 435-529-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number664882-4102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: