Individual
JEREMY BOBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2590 E PRAIRIE VIEW DR, EAGLE MOUNTAIN, UT 84005-6096
(801) 634-8938
(801) 766-1940
Mailing address
2590 E PRAIRIE VIEW DR, EAGLE MOUNTAIN, UT 84005-6096
(801) 634-8938
(801) 766-1940
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
5829317-6008
UT
1041C0700X
Clinical Social Worker
Primary
5829317-3501
UT
Other
Enumeration date
01/07/2016
Last updated
01/07/2016
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