Healthcare Provider Details

I. General information

NPI: 1417796350
Provider Name (Legal Business Name): SANDSTONE AUTISM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 400 N STE 100
SALEM UT
84653-8300
US

IV. Provider business mailing address

150 E 400 N STE 100
SALEM UT
84653-8300
US

V. Phone/Fax

Practice location:
  • Phone: 801-696-9779
  • Fax:
Mailing address:
  • Phone: 801-696-9779
  • Fax: 385-999-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: JERIANNE C ROBINSON
Title or Position: PROGRAM DIRECTOR
Credential: BCBA
Phone: 208-709-0682