Healthcare Provider Details

I. General information

NPI: 1609336130
Provider Name (Legal Business Name): SARAH WOODLAND RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S 1350 W
OREM UT
84058-3817
US

IV. Provider business mailing address

701 N 500 W APT 308
PROVO UT
84601-1487
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-8923
  • Fax:
Mailing address:
  • Phone: 952-240-4491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier802025971
Identifier TypeOTHER
Identifier State
Identifier IssuerSELECT HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: