Individual
MRS. JAN MARIE MALMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4214 S 500 W, SALT LAKE CITY, UT 84123-1336
(801) 859-3523
Mailing address
2223 AROSA CIR, SANDY, UT 84093-1039
(801) 943-5061
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4905206-6004
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11627987
CAQH
UT
Enumeration date
12/23/2006
Last updated
07/08/2007
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