Provider Demographics
NPI:1154154219
Name:ANDERSON, JAYNE (CSW)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 W 1060 S
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3971
Mailing Address - Country:US
Mailing Address - Phone:435-671-9046
Mailing Address - Fax:
Practice Address - Street 1:276 E 950 S STE 200
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-7054
Practice Address - Country:US
Practice Address - Phone:435-671-9046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14119803-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical