Provider Demographics
NPI:1548969942
Name:ROYALL, JENNA RENEE
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:RENEE
Last Name:ROYALL
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 1:723 W AUTUMN HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5996
Mailing Address - Country:US
Mailing Address - Phone:951-325-0313
Mailing Address - Fax:
Practice Address - Street 1:10808 S RIVER FRONT PKWY STE 308
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5761
Practice Address - Country:US
Practice Address - Phone:801-984-6728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11832979-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health