Provider Demographics
NPI:1801526264
Name:CLAWSON, JESSICA LYNN (CSWI)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:CLAWSON
Suffix:
Gender:F
Credentials:CSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 S MAIN ST STE 219
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2664
Mailing Address - Country:US
Mailing Address - Phone:208-681-3878
Mailing Address - Fax:
Practice Address - Street 1:1570 S 1100 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2441
Practice Address - Country:US
Practice Address - Phone:801-528-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12829259-35061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical