MEDICARE: BAYLEE TOLLEFSON RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-22-235643	UT

General Provider Information

NPI Number	:	1376269266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAYLEE TOLLEFSON RBT

Provider Business Mailing Address
First Line	:	1105 W RUSSELL ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-1322
Country	:	US
Telephone Number	:	605-271-2690
Fax Number	:	605-271-3956

Provider Business Practice Location Address
First Line	:	1438 N HIGHWAY 89
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-2944
Country	:	US
Telephone Number	:	801-200-1574
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2022
Last Update Date	:	10/13/2022

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Directions to “ BAYLEE TOLLEFSON RBT” Practice Location

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