Provider Demographics
NPI:1114507225
Name:COLLINS, JESSICA T (CPM, LDEM, BSM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:T
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CPM, LDEM, BSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E 200 S
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3404
Mailing Address - Country:US
Mailing Address - Phone:801-447-0700
Mailing Address - Fax:
Practice Address - Street 1:323 E 200 S
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3404
Practice Address - Country:US
Practice Address - Phone:801-447-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife