Provider Demographics
NPI:1013253467
Name:TIBBITTS, JESSICA JEAN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEAN
Last Name:TIBBITTS
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:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-0304
Mailing Address - Country:US
Mailing Address - Phone:435-401-3001
Mailing Address - Fax:
Practice Address - Street 1:244 W HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-3760
Practice Address - Country:US
Practice Address - Phone:435-401-3001
Practice Address - Fax:801-375-4241
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical