NPIMap

Individual provider Active NPI

Jerald J Jefferies, LCSW

  • Clinical Social Worker
  • Ogden, UT
National Provider Identifier
1407135775
Registry record updated Aug 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
119437-3501 Issued in UT
Practice address
1140 36TH St Ste 285
Ogden, UT 84403-2064
Phone
(801) 928-8567
Fax
(801) 419-0699
NPI assigned
Aug 4, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 119437-3501 UT Primary

Addresses

Primary practice location

1140 36TH St Ste 285
Ogden, UT 84403-2064

Mailing address

PO Box 3986
Salt Lake City, UT 84110-3986
Phone (801) 928-8567

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
119437-3501UTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
KT&T Ventures, LLC Past Accepting new patients
KT&T, Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312416000000",
    "number": "1407135775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3986",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841103986",
            "telephone_number": "801-928-8567",
            "fax_number": "801-419-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 36TH ST STE 285",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844032064",
            "telephone_number": "801-928-8567",
            "fax_number": "801-419-0699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFERIES",
        "first_name": "JERALD",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-04",
        "last_updated": "2011-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "119437-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.