Provider Demographics
NPI:1215347935
Name:JENNINGS, KARL EDWARD (LCSW)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:EDWARD
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 S 500 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2030
Mailing Address - Country:US
Mailing Address - Phone:801-236-7710
Mailing Address - Fax:
Practice Address - Street 1:3901 S DAVID PL
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119
Practice Address - Country:US
Practice Address - Phone:410-963-0797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374700000XNursing Service Related ProvidersTechnician