Provider Demographics
NPI:1558565259
Name:MURDOCK, JENNIE (LCSW, LMT)
Entity Type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:LCSW, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 W 2120 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5666
Mailing Address - Country:US
Mailing Address - Phone:801-341-8224
Mailing Address - Fax:
Practice Address - Street 1:193 E 860 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5012
Practice Address - Country:US
Practice Address - Phone:435-668-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT136279-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical