Healthcare Provider Details

I. General information

NPI: 1801341375
Provider Name (Legal Business Name): JILLIAN MCKINNEY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 E FT UNION BLVD
COTTONWOOD HEIGHTS UT
84121-2847
US

IV. Provider business mailing address

581 E BRIARSPRINGS CIR # 4
MIDVALE UT
84047-2782
US

V. Phone/Fax

Practice location:
  • Phone: 385-695-2203
  • Fax:
Mailing address:
  • Phone: 801-560-1227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12248745-2506
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: