Individual
JESSICA OTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12971 S SHAWNEE DR, RIVERTON, UT 84096-7805
(801) 910-5587
Mailing address
12971 S SHAWNEE DR, RIVERTON, UT 84096-7805
(801) 910-5587
(801) 206-3618
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
113051
AK
1041C0700X
Clinical Social Worker
Primary
8696808-3501
UT
1041C0700X
Clinical Social Worker
LCSW-36030
ID
1041C0700X
Clinical Social Worker
LCSW-925
WY
Other
Enumeration date
03/31/2014
Last updated
02/23/2022
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