Provider Demographics
NPI:1871220517
Name:STEED, JACIE K
Entity type:Individual
Prefix:
First Name:JACIE
Middle Name:K
Last Name:STEED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 W 20400 N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:UT
Mailing Address - Zip Code:84330-7721
Mailing Address - Country:US
Mailing Address - Phone:435-230-2380
Mailing Address - Fax:
Practice Address - Street 1:90 E 200 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4034
Practice Address - Country:US
Practice Address - Phone:435-752-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty