Healthcare Provider Details

I. General information

NPI: 1174931083
Provider Name (Legal Business Name): EMILY SAGENDORF BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 E STRINGHAM AVE RM 2
SALT LAKE CITY UT
84106-2560
US

IV. Provider business mailing address

1240 E STRINGHAM AVE RM 2
SALT LAKE CITY UT
84106-2560
US

V. Phone/Fax

Practice location:
  • Phone: 801-214-1115
  • Fax:
Mailing address:
  • Phone: 801-214-1115
  • Fax: 801-340-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number9197626-2506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: