Healthcare Provider Details

I. General information

NPI: 1881517704
Provider Name (Legal Business Name): ADVANCEABLE UT ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6543 N LANDMARK DR
PARK CITY UT
84098-5990
US

IV. Provider business mailing address

1007 BROADWAY
WOODMERE NY
11598-1227
US

V. Phone/Fax

Practice location:
  • Phone: 516-855-5504
  • Fax:
Mailing address:
  • Phone:
  • 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: MICHAEL WASSNER
Title or Position: CEO
Credential:
Phone: 646-873-0294