Provider Demographics
NPI:1083309330
Name:WHITEAR, JESSICA (RBT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WHITEAR
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:WHITEAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:4951 S MURRAY BLVD APT P34
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2725
Mailing Address - Country:US
Mailing Address - Phone:385-495-5032
Mailing Address - Fax:
Practice Address - Street 1:2811 N 2350 W
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-5177
Practice Address - Country:US
Practice Address - Phone:801-872-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BACB511198106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician