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General NPI Number Information
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NPI Number | 1548969942
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Entity Type | Individual
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Provider Name | JENNA RENEE ROYALL
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Gender | Female
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Dates
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Enumeration Date | 02/24/2023
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 10808 S RIVER FRONT PKWY STE 308
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-5761
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Country | US
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Telephone | 801-984-6728
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Fax |
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Provider Business Mailing Address
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Address Line | 723 W AUTUMN HILLS BLVD
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City | LEHI
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State | UT
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Zip | 84043-5996
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Country | US
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Telephone | 951-325-0313
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11832979-6004
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License Number State | UT
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