Provider Demographics
NPI:1548475353
Name:BERRIO, JESSICA AURORA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:AURORA
Last Name:BERRIO
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 1:10486 N CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9305
Mailing Address - Country:US
Mailing Address - Phone:801-669-6104
Mailing Address - Fax:
Practice Address - Street 1:7055 W BELL RD
Practice Address - Street 2:SUITE 21
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8544
Practice Address - Country:US
Practice Address - Phone:632-878-2037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7656912-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health