MEDICARE: JARED CHRISTIAN ROBERTSON II

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
1	106S00000X	Behavior Technician		UT

General Provider Information

NPI Number	:	1255297552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED CHRISTIAN ROBERTSON II

Provider Business Mailing Address
First Line	:	88 WASHINGTON AVE
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-1902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 E STRINGHAM AVE # 1032
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2560
Country	:	US
Telephone Number	:	801-215-1115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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