| Doctor Name: | JEANETTE P VASQUEZ |
| NPI Number: | 1477735504 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 3444653501 |
| Business Practice Address: | 2180 E 4500 S Unit #105 Holladay, UT - 841174434 |
| Business Phone Number: | 8016804728 |
| Business Fax Number: | 8017482554 |
| Mailing Address: | 5451 S 1410 E, SALT LAKE CITY |
| State: | UT |
| Postal Code: | 841177359 |
| Phone Number: | 8016804728 |
| Fax Number: | 8017482554 |
| NPI Enumeration Date: | 11/30/2007 |
| NPI Last Update Date: | 07/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 3444653501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |