MEDICARE: JESSKA BRUSCINO-LOPEZ

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	:	1942154554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSKA BRUSCINO-LOPEZ

Provider Business Mailing Address
First Line	:	2015 W GROVE PKWY
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-6739
Country	:	US
Telephone Number	:	385-548-5779
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 W GROVE PKWY
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-6739
Country	:	US
Telephone Number	:	385-548-5779
Fax Number	:

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

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	03/06/2026

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Directions to “ JESSKA BRUSCINO-LOPEZ ” Practice Location

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