Provider Demographics
NPI:1558892968
Name:MIJANGOS, JENNIFER LYNNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:MIJANGOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1950 CIRCLE OF HOPE
Mailing Address - Street 2:HUNTSMAN CANCER INSTITUTE
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112
Mailing Address - Country:US
Mailing Address - Phone:801-587-4761
Mailing Address - Fax:801-585-3046
Practice Address - Street 1:1950 CIRCLE OF HOPE
Practice Address - Street 2:HUNTSMAN CANCER INSTITUTE
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-9460
Practice Address - Country:US
Practice Address - Phone:801-587-4761
Practice Address - Fax:801-585-3046
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT566200535011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical