Healthcare Provider Details

I. General information

NPI: 1952228884
Provider Name (Legal Business Name): JENNIFER L MOONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E 100 S
SALT LAKE CITY UT
84111-1700
US

IV. Provider business mailing address

1820 S MAIN ST APT 302
SALT LAKE CITY UT
84115-2058
US

V. Phone/Fax

Practice location:
  • Phone: 801-322-3222
  • Fax:
Mailing address:
  • Phone: 385-529-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberF24-113399
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: