MEDICARE: CHRISTINA JEANNE JEFFERY CACKLER LCSW, MPH

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	101Y00000X	Counselor
2	104100000X	Social Worker	ASW60571	CA
3	1041C0700X	Clinical Social Worker	10999106-3501	UT

General Provider Information

NPI Number	:	1528515798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA JEANNE JEFFERY CACKLER LCSW, MPH

Provider Business Mailing Address
First Line	:	7533 S CENTER VIEW CT STE N
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-5526
Country	:	US
Telephone Number	:	801-228-0927
Fax Number	:

Provider Business Practice Location Address
First Line	:	7533 S CENTER VIEW CT STE N
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-5526
Country	:	US
Telephone Number	:	801-228-0927
Fax Number	:

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

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	02/07/2025

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