Healthcare Provider Details

I. General information

NPI: 1730098476
Provider Name (Legal Business Name): MELODIE ANNE JETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 BROOK ST APT A
CEDAR CITY UT
84721-6321
US

IV. Provider business mailing address

1046 BROOK ST APT A
CEDAR CITY UT
84721-6321
US

V. Phone/Fax

Practice location:
  • Phone: 435-531-1551
  • Fax:
Mailing address:
  • Phone: 435-531-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13341801-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: