MEDICARE: JESSICA ESTEP

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	103K00000X	Behavior Analyst	12076161-2506	UT

General Provider Information

NPI Number	:	1386230845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ESTEP

Provider Business Mailing Address
First Line	:	1627 W FORT RD
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-6587
Country	:	US
Telephone Number	:	916-765-2052
Fax Number	:

Provider Business Practice Location Address
First Line	:	1627 W FORT RD
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-6587
Country	:	US
Telephone Number	:	916-765-2052
Fax Number	:

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

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	12/17/2020

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Directions to “ JESSICA ESTEP ” Practice Location

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