Jentrie Tessa Allred
Individual provider Active NPI Behavior Technician · Provo, UT
NPI 1578097507 · NPPES record last updated Jun 8, 2018
Key facts
- NPI
- 1578097507
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 750 N Freedom Blvd
Provo, UT 84601 - Phone
- (801) 373-4760
- Fax
- (801) 373-0639
- NPI assigned
- Apr 17, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Utah Autism Academy | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
750 N Freedom Blvd
Provo, UT 84601
Mailing address
1875 S Geneva Rd
Orem, UT 84058-2217
Phone (801) 437-0490
Other practice location 1
750 N Freedom Blvd
Provo, UT 84601-1677
Phone (801) 373-4760
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GMM074M6754 | Medicaid | UT |
Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.