Healthcare Provider Details

I. General information

NPI: 1659792281
Provider Name (Legal Business Name): JENNIFER JOHNSON CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2013
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 W 1900 S STE 130
SYRACUSE UT
84075-9643
US

IV. Provider business mailing address

2019 W 1900 S STE 130
SYRACUSE UT
84075-9643
US

V. Phone/Fax

Practice location:
  • Phone: 801-888-4990
  • Fax:
Mailing address:
  • Phone: 801-989-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9816592-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: