Provider Demographics
NPI:1578205100
Name:BEAN, JAYLEE ANNE (BCBA)
Entity type:Individual
Prefix:
First Name:JAYLEE
Middle Name:ANNE
Last Name:BEAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3062 W 1750 N UNIT 11
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-1360
Mailing Address - Country:US
Mailing Address - Phone:435-962-1049
Mailing Address - Fax:
Practice Address - Street 1:3062 W 1750 N UNIT 11
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-1360
Practice Address - Country:US
Practice Address - Phone:435-962-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14119678-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst