Individual
JENTRIE TESSA ALLRED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601
(801) 373-4760
(801) 373-0639
Mailing address
1875 S GENEVA RD, OREM, UT 84058-2217
(801) 437-0490
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GMM074M6754
—
UT
Enumeration date
04/17/2017
Last updated
06/08/2018
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