Individual
JERAD TODACHEENIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSW
Contact information
Practice address
120 W 1300 S, SALT LAKE CITY, UT 84115-5230
(801) 214-7676
Mailing address
120 W 1300 S, SALT LAKE CITY, UT 84115-5230
(801) 214-7676
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11935171-3502
UT
Other
Enumeration date
02/07/2022
Last updated
02/07/2022
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