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NPI Code Detail

MEDICARE: TALLULAH KVENVOLD

MEDICARE: TALLULAH KVENVOLD
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
1106S00000XBehavior TechnicianUT

General Provider Information

NPI Number : 1407711617
Entity Type Code : Individual
Provider Name (Legal Business Name) : TALLULAH KVENVOLD
Provider Business Mailing Address
First Line : 16255 VENTURA BLVD STE 900
Second Line :
City : ENCINO
State : CA
Zip : 91436-2317
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2940 N CHURCH ST STE 204
Second Line :
City : LAYTON
State : UT
Zip : 84040-6616
Country : US
Telephone Number : 801-935-4171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2025
Last Update Date : 12/19/2025

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Directions to “ TALLULAH KVENVOLD ” Practice Location

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