Healthcare Provider Details

I. General information

NPI: 1013532753
Provider Name (Legal Business Name): WHITNEY POULTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W BROADWAY STE 700
SALT LAKE CITY UT
84101-2060
US

IV. Provider business mailing address

533 W STATE RD # 103
PLEASANT GROVE UT
84062-2114
US

V. Phone/Fax

Practice location:
  • Phone: 201-994-6183
  • Fax:
Mailing address:
  • Phone: 801-506-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: