| Doctor Name: | JEREMY BOBERG |
| NPI Number: | 1942666870 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 5829317-6008 |
| Business Practice Address: | 2590 E Prairie View Dr Eagle Mountain, UT - 840056096 |
| Business Phone Number: | 8016348938 |
| Business Fax Number: | 8017661940 |
| Mailing Address: | 2590 E Prairie View Dr, EAGLE MOUNTAIN |
| State: | UT |
| Postal Code: | 840056096 |
| Phone Number: | 8016348938 |
| Fax Number: | 8017661940 |
| NPI Enumeration Date: | 01/07/2016 |
| NPI Last Update Date: | 01/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 5829317-6008 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |