Provider Demographics
NPI:1699745844
Name:HALE, JESSICA LESLEY (LCSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LESLEY
Last Name:HALE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 IMPERIAL ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3614
Mailing Address - Country:US
Mailing Address - Phone:801-487-1945
Mailing Address - Fax:
Practice Address - Street 1:3809 W 6200 S
Practice Address - Street 2:
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-3725
Practice Address - Country:US
Practice Address - Phone:801-963-4275
Practice Address - Fax:801-963-4299
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14116935011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT802650OtherDESERET MUTUAL
UT107003431101OtherINTRMTN. HEALTH CARE
UT942938348HA5OtherEDUCATORS MUTUAL
UT942938348HA5OtherEDUCATORS MUTUAL