Healthcare Provider Details

I. General information

NPI: 1386108553
Provider Name (Legal Business Name): ANNIE PARNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 700 E SUITE 2A
SALT LAKE CITY UT
84102
US

IV. Provider business mailing address

3110 LONG MEADOW CT APT 204
RALEIGH NC
27613-3260
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-8923
  • Fax:
Mailing address:
  • Phone: 801-791-0621
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-77634
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: