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General NPI Number Information
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NPI Number | 1720603046
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Entity Type | Individual
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Provider Name | PHOENIX J JIMENEZ CSW
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Gender | Female
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 2940 N CHURCH ST STE 303
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City | LAYTON
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State | UT
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Zip | 84040-6617
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Country | US
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Telephone | 801-935-4171
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Fax | 385-227-8653
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Provider Business Mailing Address
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Address Line | 1375 N SCOTTSDALE RD STE 200
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-3429
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Country | US
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Telephone | 844-808-7792
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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 | 14200073-3502
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License Number State | UT
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