Provider Demographics
NPI:1306209317
Name:ROBNETT, JESSICA MICHELLE TRUSKOWSKI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MICHELLE TRUSKOWSKI
Last Name:ROBNETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3361 BUCKBOARD DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5303
Mailing Address - Country:US
Mailing Address - Phone:603-494-5274
Mailing Address - Fax:
Practice Address - Street 1:2700 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-4857
Practice Address - Country:US
Practice Address - Phone:435-200-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9518522-2501103TC0700X
UT9518522-2504390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program