Healthcare Provider Details

I. General information

NPI: 1861909699
Provider Name (Legal Business Name): JERIANNE ROBINSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
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: 385-999-6822
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 Number11008486-2507
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: