Healthcare Provider Details

I. General information

NPI: 1003740028
Provider Name (Legal Business Name): LEGACY APPLIED BEHAVIORAL ACADEMICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2873 QUINCY AVE.
OGDEN UT
84403
US

IV. Provider business mailing address

331 E 200 S
CLEARFIELD UT
84015-1007
US

V. Phone/Fax

Practice location:
  • Phone: 385-319-0395
  • Fax:
Mailing address:
  • Phone: 385-319-0395
  • 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: JEAN RODRIGUEZ REYES
Title or Position: OWNER
Credential: BCBA
Phone: 385-319-0395