Healthcare Provider Details

I. General information

NPI: 1093443798
Provider Name (Legal Business Name): JACQUELINE ELLIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1576 S 500 W
WOODS CROSS UT
84010-7433
US

IV. Provider business mailing address

1576 S 500 W
WOODS CROSS UT
84010-7433
US

V. Phone/Fax

Practice location:
  • Phone: 801-406-9002
  • Fax:
Mailing address:
  • Phone: 801-406-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14013707-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: