Provider Demographics
NPI:1235650219
Name:JEPPSON, ANNA ROSE (BCBA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ROSE
Last Name:JEPPSON
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 1:1560 E HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1726
Mailing Address - Country:US
Mailing Address - Phone:1801-688-9493
Mailing Address - Fax:
Practice Address - Street 1:4444 S 700 E STE 203
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3075
Practice Address - Country:US
Practice Address - Phone:801-688-9493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst