Provider Demographics
NPI:1366603409
Name:JEPPSEN, ROD W (LPC)
Entity type:Individual
Prefix:MR
First Name:ROD
Middle Name:W
Last Name:JEPPSEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 S 500 W
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2574
Mailing Address - Country:US
Mailing Address - Phone:801-598-3332
Mailing Address - Fax:
Practice Address - Street 1:9500 S 500 W
Practice Address - Street 2:SUITE 209
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2574
Practice Address - Country:US
Practice Address - Phone:801-598-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48935846004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional