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General NPI Number Information
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NPI Number | 1124919733
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Entity Type | Individual
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Provider Name | JORDAN ELI KWAMANAKWEENDA PSYD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 5965 S 900 E STE 100
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City | MURRAY
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State | UT
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Zip | 84121-1850
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Country | US
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Telephone | 888-762-7938
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 W 1750 S 306
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City | SALT LAKE CITY
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State | UT
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Zip | 84104-8410
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Country | US
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Telephone | 717-283-6384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 13571777-2501
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License Number State | UT
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