Healthcare Provider Details

I. General information

NPI: 1104569805
Provider Name (Legal Business Name): KIMBERLY KAY MERKLEY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
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

1443 W 800 N STE 103
OREM UT
84057-2878
US

V. Phone/Fax

Practice location:
  • Phone: 801-466-2573
  • Fax:
Mailing address:
  • Phone: 801-655-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: