Provider Demographics
NPI:1194218271
Name:SCHIPAANBOORD, JAMIE LEIGH (CSW)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEIGH
Last Name:SCHIPAANBOORD
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 1:620 MEDICAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5175
Mailing Address - Country:US
Mailing Address - Phone:801-295-2888
Mailing Address - Fax:801-295-0311
Practice Address - Street 1:620 MEDICAL DR STE 100
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5175
Practice Address - Country:US
Practice Address - Phone:801-295-2888
Practice Address - Fax:801-295-0311
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10828913-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical