Healthcare Provider Details

I. General information

NPI: 1518528975
Provider Name (Legal Business Name): ANNA GRACE TRIGG BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 N WALTON BLVD
BENTONVILLE AR
72712-4302
US

IV. Provider business mailing address

1659 N WHISTLING STRAITS AVE APT 205
FAYETTEVILLE AR
72704-6666
US

V. Phone/Fax

Practice location:
  • Phone: 479-802-4798
  • Fax: 479-668-0589
Mailing address:
  • Phone: 501-680-9101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: