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NPI Code Detail

MEDICARE: JORDAN WITBECK

MEDICARE: JORDAN WITBECK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1134567936
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN WITBECK
Provider Business Mailing Address
First Line : 1140 W 500 S STE 9
Second Line :
City : VERNAL
State : UT
Zip : 84078-2912
Country : US
Telephone Number : 435-789-6300
Fax Number : 435-725-6325
Provider Business Practice Location Address
First Line : 1140 W 500 S STE 9
Second Line :
City : VERNAL
State : UT
Zip : 84078-2912
Country : US
Telephone Number : 435-789-6300
Fax Number : 435-725-6325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2013
Last Update Date : 06/13/2013

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Directions to “ JORDAN WITBECK ” Practice Location

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