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NPI Code Detail

MEDICARE: JILLIAN MCKINNEY BCBA

MEDICARE: JILLIAN MCKINNEY BCBA
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
1251S00000XCommunity/Behavioral Health Agency
2103K00000XBehavior Analyst12248745-2506UT

General Provider Information

NPI Number : 1801341375
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILLIAN MCKINNEY BCBA
Provider Business Mailing Address
First Line : 581 E BRIARSPRINGS CIR # 4
Second Line :
City : MIDVALE
State : UT
Zip : 84047-2782
Country : US
Telephone Number : 801-560-1227
Fax Number :
Provider Business Practice Location Address
First Line : 1441 E FT UNION BLVD
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84121-2847
Country : US
Telephone Number : 385-695-2203
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2016
Last Update Date : 09/03/2024

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