Individual
JEZALYNN ILAISAANETUIKOLOVATU SITAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3539 W FENCHURCH RD, WEST JORDAN, UT 84084-3614
(385) 441-1005
Mailing address
3539 W FENCHURCH RD, WEST JORDAN, UT 84084-3614
(385) 441-1005
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
UT
Other
Enumeration date
05/05/2026
Last updated
05/05/2026
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