Healthcare Provider Details

I. General information

NPI: 1295667103
Provider Name (Legal Business Name): ANNA GRACE TELFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA GRACE BOETTCHER

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N UNIVERSITY AVE STE 270
PROVO UT
84601-5648
US

IV. Provider business mailing address

355 N 500 W APT 301
PROVO UT
84601-2629
US

V. Phone/Fax

Practice location:
  • Phone: 208-863-0091
  • Fax:
Mailing address:
  • Phone: 208-863-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: