Provider Demographics
NPI:1114394327
Name:HURDMAN, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:HURDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:801-295-4201
Practice Address - Street 1:1355 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5982
Practice Address - Country:US
Practice Address - Phone:801-259-3883
Practice Address - Fax:801-295-4201
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9424853-3502104100000X
UT9424653-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker