Individual
AMY K JEPPESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-27936
ID
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
374774-3501
UT
Other
Enumeration date
10/31/2008
Last updated
12/27/2012
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