Provider Demographics
NPI:1720581713
Name:GEMPELER, JENNY
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:GEMPELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 CELEBRATION LOOP
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84055-2108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:228 W 200 S STE 2E
Practice Address - Street 2:
Practice Address - City:KAMAS
Practice Address - State:UT
Practice Address - Zip Code:84036-9010
Practice Address - Country:US
Practice Address - Phone:801-360-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9470927-6009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional