MEDICARE: JESSICA JOHNSON CSW

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	14267449-3502	UT

General Provider Information

NPI Number	:	1922952969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA JOHNSON CSW

Provider Business Mailing Address
First Line	:	4155 S OLYMPIC WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3155
Country	:	US
Telephone Number	:	801-414-5483
Fax Number	:

Provider Business Practice Location Address
First Line	:	4516 S 700 E STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-4192
Country	:	US
Telephone Number	:	801-414-5483
Fax Number	:

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

Provider Enumeration Date	:	02/25/2026
Last Update Date	:	02/25/2026

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