Healthcare Provider Details

I. General information

NPI: 1942104740
Provider Name (Legal Business Name): JESSICA LEA BARNES CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 S 500 E
SALT LAKE CITY UT
84102-2705
US

IV. Provider business mailing address

440 S 500 E
SALT LAKE CITY UT
84102-2705
US

V. Phone/Fax

Practice location:
  • Phone: 801-359-8862
  • Fax: 801-359-8510
Mailing address:
  • Phone: 801-359-8862
  • Fax: 801-359-8510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14298949-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: