Healthcare Provider Details

I. General information

NPI: 1780435735
Provider Name (Legal Business Name): JESSE STONEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 S 900 E
SPANISH FORK UT
84660-2548
US

IV. Provider business mailing address

852 S 900 E
SPANISH FORK UT
84660-2548
US

V. Phone/Fax

Practice location:
  • Phone: 385-567-6787
  • Fax:
Mailing address:
  • Phone: 385-567-6787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: