Provider Demographics
NPI:1043913320
Name:DEVEREAUX, JENNAE (MSWI)
Entity Type:Individual
Prefix:
First Name:JENNAE
Middle Name:
Last Name:DEVEREAUX
Suffix:
Gender:F
Credentials:MSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 E 9400 S STE 100
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3677
Mailing Address - Country:US
Mailing Address - Phone:801-252-5036
Mailing Address - Fax:
Practice Address - Street 1:870 E 9400 S STE 100
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3677
Practice Address - Country:US
Practice Address - Phone:801-252-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical