Healthcare Provider Details

I. General information

NPI: 1073421053
Provider Name (Legal Business Name): KIRSTEN REIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2825 E COTTONWOOD PKWY STE 500
SALT LAKE CITY UT
84121-7060
US

IV. Provider business mailing address

440 W RIVER VIEW WAY APT A409
PROVO UT
84604-1560
US

V. Phone/Fax

Practice location:
  • Phone: 620-339-6671
  • Fax:
Mailing address:
  • Phone: 620-339-6671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: