Mrs Jennifer Poulos, LCSW, LSUDC is a medicare enrolled "Social Worker - Clinical" provider in Salt Lake City, Utah. She graduated from healthcare school in 2013 and has 12 years of diverse experience with area of expertise as Clinical Social Worker. She is a member of the group practice Valley Mental Health Incorporated and her current practice location is
4460 S Highland Dr, #230, Salt Lake City, Utah. You can reach out to her office (for appointments etc.) via phone at
(888) 949-4864.
Mrs Jennifer Poulos is licensed to practice in Utah (license number 8139526-3501) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1407153547.
Healthcare Provider's Profile
| Full Name | Mrs Jennifer Poulos |
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| Gender | Female |
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| Speciality | Clinical Social Worker |
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| Experience | 12 Years |
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| Location | 4460 S Highland Dr, Salt Lake City, Utah |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mrs Jennifer Poulos graduated from medical school in 2013
NPI Data:
- NPI Number: 1407153547
- Provider Enumeration Date: 02/25/2011
- Last Update Date: 08/14/2025
Medicare PECOS Information:
- PECOS PAC ID: 9739469321
- Enrollment ID: I20161219001158
Medical Identifiers
Medical identifiers for Mrs Jennifer Poulos such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1407153547 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 8139526-6006 (Utah) | Secondary |
| 1041C0700X | Social Worker - Clinical | 8139526-3506 (Utah) | Secondary |
| 1041C0700X | Social Worker - Clinical | 8139526-3501 (Utah) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Valley Mental Health Incorporated | 0042121196 | 62 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Jennifer Poulos allows following entities to bill medicare on her behalf.
| Entity Name | Valley Mental Health Incorporated |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1275599797
PECOS PAC ID: 0042121196
Enrollment ID: O20031111000937 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Jennifer Poulos is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mrs Jennifer Poulos, LCSW, LSUDC
3725 W 4100 S Ste 201,
Salt Lake City, UT 84120-6490
Ph: (888) 949-4864 | Mrs Jennifer Poulos, LCSW, LSUDC
4460 S Highland Dr, #230,
Salt Lake City, UT 84124-3543
Ph: (888) 949-4864 |
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