Provider Demographics
NPI:1871887901
Name:THOMSEN, JEANA (LCSW)
Entity type:Individual
Prefix:
First Name:JEANA
Middle Name:
Last Name:THOMSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9035 S 1300 E
Mailing Address - Street 2:SUITE B120
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3132
Mailing Address - Country:US
Mailing Address - Phone:801-380-4416
Mailing Address - Fax:
Practice Address - Street 1:9035 S 1300 E
Practice Address - Street 2:SUITE B120
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3132
Practice Address - Country:US
Practice Address - Phone:801-341-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5246675-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical