Provider Demographics
NPI:1316714652
Name:JAVIER, JESSICA NOEL BERRY (CSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NOEL BERRY
Last Name:JAVIER
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 1:2095 E 4500 S
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4319
Mailing Address - Country:US
Mailing Address - Phone:347-759-2265
Mailing Address - Fax:
Practice Address - Street 1:4000 S 700 E STE 9
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2581
Practice Address - Country:US
Practice Address - Phone:347-759-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT963748435021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical