MEDICARE: JENNIFER MICHELLE PANAHINIA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8672873-6004	OTHER	UT	PRIVATE INSURANCE

General Provider Information

NPI Number	:	1558708586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MICHELLE PANAHINIA

Provider Business Mailing Address
First Line	:	2460 E CAMINO WAY
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-4004
Country	:	US
Telephone Number	:	801-414-5786
Fax Number	:

Provider Business Practice Location Address
First Line	:	4578 S HIGHLAND DR STE 250
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-4200
Country	:	US
Telephone Number	:	385-800-1818
Fax Number	:

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

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	03/17/2023

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