Provider Demographics
NPI:1225634769
Name:TARBET, JESSICA JO (BCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JO
Last Name:TARBET
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W 810 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5753
Mailing Address - Country:US
Mailing Address - Phone:801-686-7860
Mailing Address - Fax:
Practice Address - Street 1:430 W 810 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5753
Practice Address - Country:US
Practice Address - Phone:801-686-7860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12474637-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst