Healthcare Provider Details

I. General information

NPI: 1447444765
Provider Name (Legal Business Name): JENIFER LAYNE GORDER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 WHISTON ST
WEST HAVEN UT
84401
US

IV. Provider business mailing address

2129 WHISTON ST
WEST HAVEN UT
84401
US

V. Phone/Fax

Practice location:
  • Phone: 801-548-2231
  • Fax:
Mailing address:
  • Phone: 801-548-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: