Healthcare Provider Details

I. General information

NPI: 1003373077
Provider Name (Legal Business Name): JANICE SMITH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 E NEWCASTLE DR
SANDY UT
84093-1621
US

IV. Provider business mailing address

2146 E NEWCASTLE DR
SANDY UT
84093-1621
US

V. Phone/Fax

Practice location:
  • Phone: 181-896-0551
  • Fax:
Mailing address:
  • Phone: 818-960-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-54584
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-18-9316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: