Provider Demographics
NPI:1205417565
Name:STEWART, JARED AARON (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:AARON
Last Name:STEWART
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 RIVER RUN DR
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-7726
Mailing Address - Country:US
Mailing Address - Phone:801-342-3436
Mailing Address - Fax:
Practice Address - Street 1:5455 RIVER RUN DR
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7726
Practice Address - Country:US
Practice Address - Phone:801-342-3436
Practice Address - Fax:801-226-8298
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1-21-48023103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst