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Individual

JESSICA FAIRBANKS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CPSS

Contact information

Practice address
3269 S MAIN ST STE 100, SOUTH SALT LAKE, UT 84115-3773
(385) 213-0578
Mailing address
3269 S MAIN ST STE 100, SOUTH SALT LAKE, UT 84115-3773
(385) 213-0578

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
F25-119270
175T00000X
Peer Specialist
Primary
1816
UT

Other

Enumeration date
10/23/2025
Last updated
10/23/2025
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