Provider Demographics
NPI:1679030613
Name:MCNEIL, JESSICA (RBT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:207 E GORDON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-2375
Mailing Address - Country:US
Mailing Address - Phone:801-663-4316
Mailing Address - Fax:
Practice Address - Street 1:207 E GORDON AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2375
Practice Address - Country:US
Practice Address - Phone:801-663-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician