Provider Demographics
NPI:1275396202
Name:HOUSTON, JENNIFER LEE (CSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 E MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1251
Mailing Address - Country:US
Mailing Address - Phone:801-641-6198
Mailing Address - Fax:
Practice Address - Street 1:668 E MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1251
Practice Address - Country:US
Practice Address - Phone:801-641-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12849289-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical