Healthcare Provider Details

I. General information

NPI: 1154239101
Provider Name (Legal Business Name): NOAH ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E COTTONWOOD PKWY STE 500
COTTONWOOD HEIGHTS UT
84121-7060
US

IV. Provider business mailing address

622 W 900 N
AMERICAN FORK UT
84003-5151
US

V. Phone/Fax

Practice location:
  • Phone: 801-822-8422
  • Fax:
Mailing address:
  • Phone: 801-822-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: