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General NPI Number Information
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NPI Number | 1417025040
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Entity Type | Individual
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Provider Name | JESSE KATHERINE VAZZANO LICSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | VA SALT LAKE CITY HEALTH CARE SYSTEM 500 FOOTHILL BLVD
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City | SALT LAKE CITY
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State | UT
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Zip | 84148
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Country | US
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Telephone | 801-582-1565
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Fax |
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Provider Business Mailing Address
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Address Line | VA SALT LAKE CITY HEALTH CARE SYSTEM 500 FOOTHILL BLVD
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City | SALT LAKE CITY
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State | UT
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Zip | 84148
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Country | US
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Telephone | 801-582-1565
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089.0046104
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14228253-3501
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License Number State | UT
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