Individual
JAMIE MICHELLE MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5770 S 1500 W, BLDG. G, SALT LAKE CITY, UT 84123-5216
(801) 313-7770
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 313-7770
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8272237-3501
UT
Other
Enumeration date
06/18/2014
Last updated
01/07/2015
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