Individual
JENNIFER CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMCH MAC
Contact information
Practice address
8375 SOUTH 700EAST, SANDY, UT 84070
(801) 576-0745
Mailing address
8375 S 700 E, SANDY, UT 84070-0504
(801) 576-0745
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
8336873-6004
UT
324500000X
Substance Abuse Rehabilitation Facility
Primary
8336873-6004
UT
Other
Enumeration date
03/16/2017
Last updated
03/16/2017
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