Provider Demographics
NPI:1639900970
Name:ERICKSEN, JENNIFER ALLEN (CSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALLEN
Last Name:ERICKSEN
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 1:1434 N 2475 W
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-7763
Mailing Address - Country:US
Mailing Address - Phone:801-513-8875
Mailing Address - Fax:
Practice Address - Street 1:563 W 500 S STE 440
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8296
Practice Address - Country:US
Practice Address - Phone:385-503-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13964016-3502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health