Healthcare Provider Details

I. General information

NPI: 1710329818
Provider Name (Legal Business Name): JESSICA SEAWRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA THEEL

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E 100 S STE 301
SLC UT
84111-1700
US

IV. Provider business mailing address

995 S LINCOLN ST #4
SLC UT
84105-1477
US

V. Phone/Fax

Practice location:
  • Phone: 801-322-4257
  • Fax:
Mailing address:
  • Phone: 801-557-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131815
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: