Provider Demographics
NPI:1861820813
Name:SUMNER, JAYNE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:ANN
Last Name:SUMNER
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 1:1166 N 220 W UNIT 128
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9074
Mailing Address - Country:US
Mailing Address - Phone:801-413-3740
Mailing Address - Fax:
Practice Address - Street 1:1166 N 220 W UNIT 128
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9074
Practice Address - Country:US
Practice Address - Phone:435-241-2857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10389114-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical