Provider Demographics
NPI:1154163590
Name:SWARTZ, JENNIE
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:SWARTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 E 1000 N APT W1
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-2588
Mailing Address - Country:US
Mailing Address - Phone:843-806-9745
Mailing Address - Fax:
Practice Address - Street 1:6405 OLD MAIN HILL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-6405
Practice Address - Country:US
Practice Address - Phone:435-797-4200
Practice Address - Fax:844-308-5865
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTBACB1128680106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician