Provider Demographics
NPI:1023668381
Name:GEORGIO, JESSICA (AMFT, LASUDC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GEORGIO
Suffix:
Gender:F
Credentials:AMFT, LASUDC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASUDC
Mailing Address - Street 1:4516 S 700 E STE 360
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8317
Mailing Address - Country:US
Mailing Address - Phone:385-231-8387
Mailing Address - Fax:
Practice Address - Street 1:750 N FREEDOM BLVD
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1677
Practice Address - Country:US
Practice Address - Phone:801-373-4760
Practice Address - Fax:801-373-0639
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator