Healthcare Provider Details

I. General information

NPI: 1083482988
Provider Name (Legal Business Name): BLUE GEMS ABA THERAPY UT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 S 300 W STE 200
SANDY UT
84070-3654
US

IV. Provider business mailing address

9980 S 300 W STE 200
SANDY UT
84070-3654
US

V. Phone/Fax

Practice location:
  • Phone: 801-466-2573
  • Fax: 617-340-3371
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DAVID WOLF
Title or Position: CEO
Credential:
Phone: 617-297-7998