Individual
JORDAN KONCINSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, MS
Contact information
Practice address
81 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1125
(801) 662-5702
Mailing address
81 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1125
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
10964186-1205
UT
2084P0800X
Psychiatry Physician
10964186-1205
UT
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
10964186-1205
UT
Other
Enumeration date
04/03/2017
Last updated
10/20/2022
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