Provider Demographics
NPI:1780117556
Name:JENNY JO HOLDINGS INCE
Entity type:Organization
Organization Name:JENNY JO HOLDINGS INCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNVER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCS
Authorized Official - Phone:801-214-1582
Mailing Address - Street 1:2840 S BEVERLY ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3170
Mailing Address - Country:US
Mailing Address - Phone:801-913-0760
Mailing Address - Fax:
Practice Address - Street 1:2180 E 4500 S
Practice Address - Street 2:SUITE 105
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4434
Practice Address - Country:US
Practice Address - Phone:801-214-1582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT573498635011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty