Provider Demographics
NPI:1619015278
Name:SQUIRE, JENNIFER S (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:SQUIRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7084 S 2300 E STE 120
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3978
Mailing Address - Country:US
Mailing Address - Phone:801-808-2410
Mailing Address - Fax:
Practice Address - Street 1:7084 S 2300 E STE 120
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3978
Practice Address - Country:US
Practice Address - Phone:801-808-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT35320235011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical