Provider Demographics
NPI:1710782461
Name:LEE, JENIFER (SSW)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 W 9800 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-2324
Mailing Address - Country:US
Mailing Address - Phone:608-216-5453
Mailing Address - Fax:
Practice Address - Street 1:1234 W SOUTH JORDAN PKWY STE B2
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4649
Practice Address - Country:US
Practice Address - Phone:801-821-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker