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NPI Code Detail

MEDICARE: BAILEY JACKSON

MEDICARE: BAILEY JACKSON
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
1106S00000XBehavior TechnicianUT

General Provider Information

NPI Number : 1588519649
Entity Type Code : Individual
Provider Name (Legal Business Name) : BAILEY JACKSON
Provider Business Mailing Address
First Line : 16255 VENTURA BLVD STE 830
Second Line :
City : ENCINO
State : CA
Zip : 91436-2317
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 240 MORRIS AVE STE 100
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-3278
Country : US
Telephone Number : 801-935-4171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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Directions to “ BAILEY JACKSON ” Practice Location

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