MEDICARE: KOBE JEPPESEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	14223866-3502	UT

General Provider Information

NPI Number	:	1205528262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOBE JEPPESEN

Provider Business Mailing Address
First Line	:	275 E SOUTH TEMPLE STE 103
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1323
Country	:	US
Telephone Number	:	801-382-7265
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 E SOUTH TEMPLE STE 103
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1323
Country	:	US
Telephone Number	:	801-382-7265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	09/04/2025

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Directions to “ KOBE JEPPESEN ” Practice Location

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