Provider Demographics
NPI:1982214680
Name:TODD, JENIFER RICHARDS
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:RICHARDS
Last Name:TODD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4137 GOLDEN GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:ERDA
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9563
Mailing Address - Country:US
Mailing Address - Phone:385-419-6049
Mailing Address - Fax:
Practice Address - Street 1:272 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2244
Practice Address - Country:US
Practice Address - Phone:385-419-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician