Individual
JESSICA JOHSTONEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
266 W 4020 N, PROVO, UT 84604-4996
(801) 369-4770
Mailing address
266 W 4020 N, PROVO, UT 84604-4996
(801) 369-4770
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7839843-4102
UT
Other
Enumeration date
01/27/2020
Last updated
01/27/2020
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