Individual
JESSICA MIGNON PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
117 W 400 S, SALT LAKE CITY, UT 84101-1916
(801) 428-4257
Mailing address
117 W 400 S, SALT LAKE CITY, UT 84101-1916
(801) 428-4257
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
F26-1155666
UT
172V00000X
Community Health Worker
Primary
F26-1155666
UT
172V00000X
Community Health Worker
Primary
—
—
175T00000X
Peer Specialist
Primary
F24-115566
UT
Other
Enumeration date
02/24/2025
Last updated
07/28/2026
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