Provider Demographics
NPI:1881268225
Name:DUPLESSY, JENNICA MCKEAN (106S00000X)
Entity type:Individual
Prefix:MS
First Name:JENNICA
Middle Name:MCKEAN
Last Name:DUPLESSY
Suffix:
Gender:F
Credentials:106S00000X
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:MCKEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:106S00000X
Mailing Address - Street 1:1140 W 1130 S
Mailing Address - Street 2:BUILDING B
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-2888
Mailing Address - Country:US
Mailing Address - Phone:801-935-4946
Mailing Address - Fax:
Practice Address - Street 1:1140 W 1130 S
Practice Address - Street 2:BUILDING B
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-2888
Practice Address - Country:US
Practice Address - Phone:801-935-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician