Provider Demographics
NPI:1770762742
Name:SCHEFFRES, JONATHON BEN (LPC)
Entity type:Individual
Prefix:MR
First Name:JONATHON
Middle Name:BEN
Last Name:SCHEFFRES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 S 700 E
Mailing Address - Street 2:B-344
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2161
Mailing Address - Country:US
Mailing Address - Phone:801-633-3908
Mailing Address - Fax:
Practice Address - Street 1:1550 E 3300 S
Practice Address - Street 2:B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3311
Practice Address - Country:US
Practice Address - Phone:801-633-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT000000000000000226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist