Provider Demographics
NPI:1942706080
Name:WOOTTON, JASON PAUL (LCSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:WOOTTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 N COZY LN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-6620
Mailing Address - Country:US
Mailing Address - Phone:801-319-0192
Mailing Address - Fax:
Practice Address - Street 1:1748 N COZY LN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-6620
Practice Address - Country:US
Practice Address - Phone:801-319-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT307989-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical