Healthcare Provider Details

I. General information

NPI: 1497419501
Provider Name (Legal Business Name): BRANDON JAY JOHNSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10808 S RIVER FRONT PKWY STE 352
SOUTH JORDAN UT
84095-5761
US

IV. Provider business mailing address

10808 S RIVER FRONT PKWY STE 352
SOUTH JORDAN UT
84095-5761
US

V. Phone/Fax

Practice location:
  • Phone: 801-471-4585
  • Fax:
Mailing address:
  • Phone: 801-471-4585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8603913-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: