Provider Demographics
NPI:1710683529
Name:REZA, JODILYN (LCSW)
Entity Type:Individual
Prefix:
First Name:JODILYN
Middle Name:
Last Name:REZA
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 1:1730 E 3100 N STE 2
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-2408
Mailing Address - Country:US
Mailing Address - Phone:385-419-1330
Mailing Address - Fax:
Practice Address - Street 1:1730 E 3100 N STE 2
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-2408
Practice Address - Country:US
Practice Address - Phone:801-525-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12337292-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical