Provider Demographics
NPI:1184456022
Name:CORTES MICHEL, JENNIFER ALEXA (MSWI)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALEXA
Last Name:CORTES MICHEL
Suffix:
Gender:F
Credentials:MSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 W 680 N
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1423
Mailing Address - Country:US
Mailing Address - Phone:385-255-6574
Mailing Address - Fax:
Practice Address - Street 1:4695 S 1900 W STE 6
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-2669
Practice Address - Country:US
Practice Address - Phone:801-931-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical