Provider Demographics
NPI:1457184079
Name:GROW, JESSICA (CSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:GROW
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 W COLD POND AVE
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4429
Mailing Address - Country:US
Mailing Address - Phone:951-391-2923
Mailing Address - Fax:
Practice Address - Street 1:394 W MAIN ST STE AND205
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2035
Practice Address - Country:US
Practice Address - Phone:801-215-9096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14139329-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker