Provider Demographics
NPI:1376979682
Name:SOLOSKO, JENNIFER (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SOLOSKO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11075 S STATE ST
Mailing Address - Street 2:UNIT 3, SUITE 102
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5164
Mailing Address - Country:US
Mailing Address - Phone:801-890-5151
Mailing Address - Fax:801-890-5152
Practice Address - Street 1:11075 S STATE ST
Practice Address - Street 2:UNIT 3, SUITE 102
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5164
Practice Address - Country:US
Practice Address - Phone:801-890-5151
Practice Address - Fax:801-890-5152
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8773008-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist