MEDICARE: EMILY JARDINE

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	106H00000X	Marriage & Family Therapist	12900569-3902	UT
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1356017776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY JARDINE

Provider Business Mailing Address
First Line	:	189 N HIGHWAY 89
Second Line	:	STE C PMB 3009
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054
Country	:	US
Telephone Number	:	435-932-0311
Fax Number	:

Provider Business Practice Location Address
First Line	:	2943 W PARKWAY BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84119-1986
Country	:	US
Telephone Number	:	435-932-0311
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	03/20/2026

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Directions to “ EMILY JARDINE ” Practice Location

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