Healthcare Provider Details

I. General information

NPI: 1255246104
Provider Name (Legal Business Name): JESSICA ANDERSON CD, CB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S MAIN ST STE 101
BRIGHAM CITY UT
84302-6794
US

IV. Provider business mailing address

PO BOX 87
CORINNE UT
84307-0087
US

V. Phone/Fax

Practice location:
  • Phone: 435-760-8358
  • Fax:
Mailing address:
  • Phone: 435-767-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: