Provider Demographics
NPI:1295725216
Name:WEISS, JANE A (MSW)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:WEISS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 WASATCH BLVD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4709
Mailing Address - Country:US
Mailing Address - Phone:801-273-7514
Mailing Address - Fax:801-273-7514
Practice Address - Street 1:4505 WASATCH BLVD
Practice Address - Street 2:SUITE 380
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84124-4709
Practice Address - Country:US
Practice Address - Phone:801-273-7514
Practice Address - Fax:801-273-7514
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13607035011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical