Provider Demographics
NPI:1336799923
Name:SERDAR, JESSICA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:SERDAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 N FREEDOM BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1677
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5455 RIVER RUN DR
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7726
Practice Address - Country:US
Practice Address - Phone:801-226-2550
Practice Address - Fax:801-226-8298
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical