Healthcare Provider Details

I. General information

NPI: 1639078959
Provider Name (Legal Business Name): KASIAH BALLARD RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2026
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12055 S 700 E
DRAPER UT
84020-9746
US

IV. Provider business mailing address

95 E 2200 S
BOUNTIFUL UT
84010-5619
US

V. Phone/Fax

Practice location:
  • Phone: 801-980-7970
  • Fax: 801-852-0436
Mailing address:
  • Phone: 801-980-7970
  • Fax: 801-852-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2865496
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: