| Doctor Name: | DR. JENNIFER ANNE NIBLEY CANNON |
| NPI Number: | 1104127869 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 7429787-2501 |
| Business Practice Address: | 796 E Pacific Dr Ste B American Fork, UT - 840033161 |
| Business Phone Number: | 8017561626 |
| Business Fax Number: | 8017561627 |
| Mailing Address: | 560 W 800 N, OREM |
| State: | UT |
| Postal Code: | 840573746 |
| Phone Number: | 8012256246 |
| Fax Number: | 8012251525 |
| NPI Enumeration Date: | 11/11/2010 |
| NPI Last Update Date: | 04/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 7429787-2501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |