Provider Demographics
NPI:1710547138
Name:BEAUMONT, JENESSA PAIGE
Entity Type:Individual
Prefix:
First Name:JENESSA
Middle Name:PAIGE
Last Name:BEAUMONT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W 2000 N
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3501
Mailing Address - Country:US
Mailing Address - Phone:801-362-7003
Mailing Address - Fax:
Practice Address - Street 1:20 W 2000 N
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-3501
Practice Address - Country:US
Practice Address - Phone:801-362-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11256819-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty