Provider Demographics
NPI:1346211919
Name:SMITH, JODI ANN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:JODI
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2119
Mailing Address - Country:US
Mailing Address - Phone:801-487-5824
Mailing Address - Fax:
Practice Address - Street 1:VALLEY MENTAL HEALTH CTP
Practice Address - Street 2:3944 SOUTH 400 EAST
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-261-1442
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT37342635011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT682028OtherDESERET MUTUAL
UT942938348011OtherCHAMPUS
UT107021470101OtherINTERMNT HEALTH CARE
UTQ10581Medicare ID - Type UnspecifiedMEDICARE ADVANTAGE PLAN