Provider Demographics
NPI:1679176028
Name:KOYLE, JENI SCARLETT (CSW)
Entity Type:Individual
Prefix:
First Name:JENI
Middle Name:SCARLETT
Last Name:KOYLE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 W 1700 S STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-3461
Mailing Address - Country:US
Mailing Address - Phone:801-972-2711
Mailing Address - Fax:801-972-2709
Practice Address - Street 1:292 ODELL LN APT 4
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-4107
Practice Address - Country:US
Practice Address - Phone:801-218-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11841804-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical