Active NPI
Jayne Olivia Broadbent
- Social Worker
- Pleasant Grove, UT
National Provider Identifier
1952144909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 14003877-3502
- Practice address
- 1384 W State Rd
Pleasant Grove, UT 84062-4130 - Phone
- (385) 202-4089
- NPI assigned
- Jun 17, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 14003877-3502 | UT | Primary |
Addresses
Primary practice location
1384 W State Rd
Pleasant Grove, UT 84062-4130
Mailing address
4167 W 12050 S
Riverton, UT 84096-7747
Phone (385) 695-7046
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
| License | State | Type | Specialty |
|---|---|---|---|
| 14003877-3502 | UT | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Penelope Bergeron Counseling | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Spanish Fork, UT
- NPI 1275110769
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718582400000",
"number": "1952144909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4167 W 12050 S",
"city": "RIVERTON",
"state": "UT",
"postal_code": "840967747",
"telephone_number": "385-695-7046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1384 W STATE RD",
"city": "PLEASANT GROVE",
"state": "UT",
"postal_code": "840624130",
"telephone_number": "385-202-4089"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROADBENT",
"first_name": "JAYNE",
"middle_name": "OLIVIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-17",
"last_updated": "2024-06-17",
"certification_date": "2024-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "UT",
"license": "14003877-3502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasant Grove, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.