Healthcare Provider Details

I. General information

NPI: 1376454728
Provider Name (Legal Business Name): SAVANNAH JESSUP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2689 S 1700 E
SALT LAKE CITY UT
84106-3636
US

IV. Provider business mailing address

2689 S 1700 E
SALT LAKE CITY UT
84106-3636
US

V. Phone/Fax

Practice location:
  • Phone: 760-835-9798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: