Provider Demographics
NPI:1548522089
Name:PEARSON, JENNIFER S
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:PEARSON
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 1:25 N 100 E STE 102
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7369
Mailing Address - Country:US
Mailing Address - Phone:435-879-5105
Mailing Address - Fax:435-986-2577
Practice Address - Street 1:25 N 100 E STE 102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7369
Practice Address - Country:US
Practice Address - Phone:435-879-5105
Practice Address - Fax:435-986-2577
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86532516009101YM0800X
UT8653251-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health