Healthcare Provider Details

I. General information

NPI: 1700479946
Provider Name (Legal Business Name): MELISSA BOSMANN CBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8031 S 700 E
SANDY UT
84070-0555
US

IV. Provider business mailing address

939 S ASPEN LOOP
PROVO UT
84606-6451
US

V. Phone/Fax

Practice location:
  • Phone: 877-222-4621
  • Fax:
Mailing address:
  • Phone: 425-772-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: