Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 5189397-6004 | UT |
NPI | 1003039280 |
---|---|
Provider Name | Mrs. Ginger Jones |
First Address | Ogden, UT 84401-3105 |
Second Address | Ogden, UT 84401-3105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 09/07/2007 |