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General NPI Number Information
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NPI Number | 1356017776
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Entity Type | Individual
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Provider Name | EMILY JARDINE
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Gender | Female
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 189 N HIGHWAY 89 STE C PMB 3009
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-2463
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Country | US
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Telephone | 435-932-0311
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Fax |
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Provider Business Mailing Address
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Address Line | 189 N HIGHWAY 89 STE C PMB 3009
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054
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Country | US
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Telephone | 435-932-0311
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 12900569-3902
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License Number State | UT
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