Healthcare Provider Details

I. General information

NPI: 1356017776
Provider Name (Legal Business Name): EMILY JARDINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2943 W PARKWAY BLVD
SALT LAKE CITY UT
84119-1986
US

IV. Provider business mailing address

189 N HIGHWAY 89 STE C PMB 3009
NORTH SALT LAKE UT
84054
US

V. Phone/Fax

Practice location:
  • Phone: 435-932-0311
  • Fax:
Mailing address:
  • Phone: 435-932-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number12900569-3902
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: