Healthcare Provider Details

I. General information

NPI: 1629690862
Provider Name (Legal Business Name): SUTTON OLIVIA VARGO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 S WEST TEMPLE
SALT LAKE CITY UT
84115-1816
US

IV. Provider business mailing address

1776 S WEST TEMPLE
SALT LAKE CITY UT
84115-1816
US

V. Phone/Fax

Practice location:
  • Phone: 801-880-5775
  • Fax:
Mailing address:
  • Phone: 801-880-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-70991
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: