Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ejay Jack, LCSW

Individual provider Clinical Social Worker · NPI 1306500590

Ejay Jack, LCSW is a Clinical Social Worker in Salt Lake City, Utah. Licensed in Minnesota and Utah. Registered with an NPI since 2021.

Licensed in
MN, UT
In the registry since
2021
Specialties on file
2
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

389 S 900 E
Salt Lake City, UT 84102-2310
Phone: (385) 282-2500
Fax: (385) 282-2501
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 12490452-3501 (UT)
Clinical Social Worker Taxonomy 1041C0700X · Licence 24475 (MN)

Record details

NPI number1306500590
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorNo
NPI enumeratedOctober 25, 2021
Last updated in NPPESOctober 25, 2021
Certification dateOctober 25, 2021

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