Jessica Lacey Fisher Champlin, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10853410-3501 Issued in UT

Practice address

1290 S 500 W Ste 300
Woods Cross, UT 84010-8104

Phone

(801) 215-9575

Fax

(833) 904-1668

NPI assigned

Mar 24, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Jessica Lacey Fisher Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1490313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1851822464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 N 190 E",
            "city": "NORTH SALT LAKE",
            "state": "UT",
            "postal_code": "840542200",
            "telephone_number": "801-215-9575",
            "fax_number": "833-904-1668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 S 500 W STE 300",
            "city": "WOODS CROSS",
            "state": "UT",
            "postal_code": "840108104",
            "telephone_number": "801-215-9575",
            "fax_number": "833-904-1668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 E 400 S",
            "address_purpose": "LOCATION",
            "city": "Bountiful",
            "state": "UT",
            "postal_code": "840104919",
            "country_code": "US",
            "telephone_number": "801-215-9575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FISHER CHAMPLIN",
        "first_name": "JESSICA",
        "middle_name": "LACEY",
        "name_prefix": "Mrs.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-24",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "10853410-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "FISHER",
            "middle_name": "LACEY",
            "prefix": "MS.",
            "credential": "L.C.S.W.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Woods Cross, UT
• Providers in Woods Cross, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; 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.