Provider Demographics
NPI:1609477819
Name:CHARLESWORTH, JAIMEE L (BS, CSW)
Entity type:Individual
Prefix:
First Name:JAIMEE
Middle Name:L
Last Name:CHARLESWORTH
Suffix:
Gender:F
Credentials:BS, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 HERITAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-7063
Mailing Address - Country:US
Mailing Address - Phone:801-628-0414
Mailing Address - Fax:801-683-8962
Practice Address - Street 1:172 N EAST PROMONTORY STE 270
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2964
Practice Address - Country:US
Practice Address - Phone:801-940-5184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14015801-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker