Healthcare Provider Details

I. General information

NPI: 1356160774
Provider Name (Legal Business Name): JAIDY WARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 N 1950 W
SALT LAKE CITY UT
84116-3100
US

IV. Provider business mailing address

195 N 1950 W
SALT LAKE CITY UT
84116-3100
US

V. Phone/Fax

Practice location:
  • Phone: 385-910-2636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: