Healthcare Provider Details

I. General information

NPI: 1235650219
Provider Name (Legal Business Name): ANNA ROSE JEPPSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 S 700 E STE 203
MURRAY UT
84107-3075
US

IV. Provider business mailing address

1560 E HARVARD AVE
SALT LAKE CITY UT
84105-1726
US

V. Phone/Fax

Practice location:
  • Phone: 801-688-9493
  • Fax:
Mailing address:
  • Phone: 18016889493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: