Healthcare Provider Details

I. General information

NPI: 1386347847
Provider Name (Legal Business Name): KILEY JO GERMAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KILEY JO GERMAIN

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 W SERGEANT COURT DR STE 204
SARATOGA SPRINGS UT
84045-5809
US

IV. Provider business mailing address

71 E 600 N
OREM UT
84057-4087
US

V. Phone/Fax

Practice location:
  • Phone: 801-987-6333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB897315
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: