| Mrs Jan Marie Malmberg, LPC | |
|
4214 S 500 W, Salt Lake City, UT 84123-1336 | |
| (801) 859-3523 | |
| Not Available |
| Full Name | Mrs Jan Marie Malmberg |
|---|---|
| Gender | Female |
| Speciality | Mental Health Counselor |
| Experience | 31 Years |
| Location | 4214 S 500 W, Salt Lake City, Utah |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225193998 | NPI | - | NPPES |
| 11627987 | Other | UT | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 4905206-6004 (Utah) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Jennifer Fairbourn Lmft Llc | 5294116455 | 4 |
| Entity Name | Jennifer Fairbourn Lmft Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1356826036 PECOS PAC ID: 5294116455 Enrollment ID: O20220719002188 |
| Mailing Address | Practice Location Address |
|---|---|
| Mrs Jan Marie Malmberg, LPC 2223 Arosa Cir, Sandy, UT 84093-1039 Ph: (801) 943-5061 | Mrs Jan Marie Malmberg, LPC 4214 S 500 W, Salt Lake City, UT 84123-1336 Ph: (801) 859-3523 |
Douglas Ray Stafford, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 411 Grant St, Salt Lake City, UT 84116 Phone: 801-359-8862 | |
Mr. Siope Lee Kinikini, CHMC Counselor Medicare: Not Enrolled in Medicare Practice Location: 5800 Highland Dr, Salt Lake City, UT 84121 Phone: 801-272-9980 Fax: 801-272-9976 | |
Jesenia Sanchez, Counselor Medicare: Not Enrolled in Medicare Practice Location: 607 E 200 S, Salt Lake City, UT 84102 Phone: 801-363-0203 Fax: 801-359-3455 | |
Steven Alec Jensen, Counselor Medicare: Not Enrolled in Medicare Practice Location: 5965 S 900 E, Salt Lake City, UT 84121 Phone: 801-263-7100 | |
Austin Giove, Counselor Medicare: Not Enrolled in Medicare Practice Location: 5965 S 900 E, Salt Lake City, UT 84121 Phone: 801-263-7100 | |
Clarissa Weiss, Counselor Medicare: Not Enrolled in Medicare Practice Location: 5965 S 900 E, Salt Lake City, UT 84121 Phone: 801-263-7100 | |
Katalina Takuvaka, Counselor Medicare: Not Enrolled in Medicare Practice Location: 4460 S Highland Dr Ste 210, Salt Lake City, UT 84124 Phone: 888-949-4864 |