Provider Demographics
NPI:1194196162
Name:YARGER, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:YARGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 N STONNE LN
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1188
Mailing Address - Country:US
Mailing Address - Phone:385-321-7880
Mailing Address - Fax:
Practice Address - Street 1:3950 W 4100 S
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-8815
Practice Address - Country:US
Practice Address - Phone:385-321-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9550469-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1132OtherDEPARTMENT OF PUBLIC HEALTH
32891472OtherINTERNATIONAL BEHAVIOR ANALYSIS ORGANIZATION
UT9550469-2506OtherDEPARTMENT OF OCCUPATIONAL AND PROFESSIONAL LICENSING
NVLBA0556OtherAGING AND DISABILITY SERVICES DIVISION