Provider Demographics
NPI:1043563836
Name:ANDES, JARED (CSW)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:
Last Name:ANDES
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 572070
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84157-2070
Mailing Address - Country:US
Mailing Address - Phone:801-263-7138
Mailing Address - Fax:801-263-7203
Practice Address - Street 1:1141 E 3900 S
Practice Address - Street 2:STE A170
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1215
Practice Address - Country:US
Practice Address - Phone:801-293-7400
Practice Address - Fax:801-284-4991
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8619093-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical