Provider Demographics
NPI:1821546300
Name:STENQUIST, JESSICA JO (TRS, CTRS, MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA JO
Middle Name:
Last Name:STENQUIST
Suffix:
Gender:F
Credentials:TRS, CTRS, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 S 1200 E
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2425
Mailing Address - Country:US
Mailing Address - Phone:801-369-4493
Mailing Address - Fax:
Practice Address - Street 1:6746 EAST US89
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741
Practice Address - Country:US
Practice Address - Phone:435-644-3654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6387576-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical