Healthcare Provider Details

I. General information

NPI: 1184554701
Provider Name (Legal Business Name): ADREANNE JADE POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS JADE POWELL

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S MAIN ST STE 2
TOOELE UT
84074-2784
US

IV. Provider business mailing address

4107 S SANDPIPER LN
SARATOGA SPRINGS UT
84045-3808
US

V. Phone/Fax

Practice location:
  • Phone: 435-849-3067
  • Fax:
Mailing address:
  • Phone: 435-849-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6134365-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: