Provider Demographics
NPI:1528574324
Name:MALDONADO, JENNIFER LEE (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:MALDONADO
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 1:11613 S SKYWARD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-1353
Mailing Address - Country:US
Mailing Address - Phone:801-608-3564
Mailing Address - Fax:
Practice Address - Street 1:11613 S SKYWARD RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-1353
Practice Address - Country:US
Practice Address - Phone:801-608-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-17
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10074701-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist