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NPI Code Detail

MEDICARE: JARED WAYNE JENSEN

MEDICARE: JARED WAYNE JENSEN
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
11041C0700XClinical Social Worker12884231-3501UT

General Provider Information

NPI Number : 1710511464
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARED WAYNE JENSEN
Provider Business Mailing Address
First Line : 2276 WASHINGTON BLVD APT 532
Second Line :
City : OGDEN
State : UT
Zip : 84401-1453
Country : US
Telephone Number : 385-244-6942
Fax Number :
Provider Business Practice Location Address
First Line : 880 HERITAGE PARK BLVD STE 130
Second Line :
City : LAYTON
State : UT
Zip : 84041-5674
Country : US
Telephone Number : 385-244-6942
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2020
Last Update Date : 04/30/2025

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