Healthcare Provider Details

I. General information

NPI: 1851036578
Provider Name (Legal Business Name): DANIELLE MARIE DEISHER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E BROADWAY 203, #1172
SALT LAKE CITY UT
84111
US

IV. Provider business mailing address

30 E BROADWAY
SALT LAKE CITY UT
84111-2227
US

V. Phone/Fax

Practice location:
  • Phone: 801-630-8420
  • Fax:
Mailing address:
  • Phone: 801-630-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-78854
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: