Provider Demographics
NPI:1841773207
Name:HALLISEY, JENNY TAYLOR (MSW, IN PROCESS)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:TAYLOR
Last Name:HALLISEY
Suffix:
Gender:F
Credentials:MSW, IN PROCESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S MAIN ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1884
Mailing Address - Country:US
Mailing Address - Phone:801-900-8130
Mailing Address - Fax:
Practice Address - Street 1:25 S MAIN ST STE 100A
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1884
Practice Address - Country:US
Practice Address - Phone:801-900-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker