Healthcare Provider Details

I. General information

NPI: 1922952969
Provider Name (Legal Business Name): JESSICA JOHNSON CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 S 700 E STE 200
SALT LAKE CITY UT
84107-4192
US

IV. Provider business mailing address

4155 S OLYMPIC WAY
SALT LAKE CITY UT
84124-3155
US

V. Phone/Fax

Practice location:
  • Phone: 801-414-5483
  • Fax:
Mailing address:
  • Phone: 801-414-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14267449-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: