Basic Information
| Provider Information | |||||||||
| NPI: | 1699726364 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | ASAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHD, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1076 IRON WOOD DR | ||||||||
| Address2: | |||||||||
| City: | ERDA | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840749766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019691166 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 FOOTHILL DR | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015821565 | ||||||||
| FaxNumber: | 8015845609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 118066-3501 | UT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.