Provider Demographics
NPI:1477735504
Name:VASQUEZ, JEANETTE P (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:P
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:P
Other - Last Name:KUHRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5451 S 1410 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7359
Mailing Address - Country:US
Mailing Address - Phone:801-680-4728
Mailing Address - Fax:801-748-2554
Practice Address - Street 1:2180 E 4500 S
Practice Address - Street 2:UNIT #105
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4434
Practice Address - Country:US
Practice Address - Phone:801-680-4728
Practice Address - Fax:801-748-2554
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT34446535011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical