Healthcare Provider Details

I. General information

NPI: 1124938634
Provider Name (Legal Business Name): EMILY JEDERLINICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11202 S ALPINE CREEK WAY
SOUTH JORDAN UT
84095-8492
US

IV. Provider business mailing address

11202 S ALPINE CREEK WAY
SOUTH JORDAN UT
84095-8492
US

V. Phone/Fax

Practice location:
  • Phone: 541-740-5525
  • Fax:
Mailing address:
  • Phone: 844-924-7325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3885591
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: