Healthcare Provider Details

I. General information

NPI: 1801542352
Provider Name (Legal Business Name): GABRIELLE NICOLE PAULSIN CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELLE NICOLE JEFFERIES RBT

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1654 W REUNION AVE STE 10B
SOUTH JORDAN UT
84095-4676
US

IV. Provider business mailing address

1654 W REUNION AVE STE 10B
SOUTH JORDAN UT
84095-4676
US

V. Phone/Fax

Practice location:
  • Phone: 801-349-2480
  • Fax:
Mailing address:
  • Phone: 801-349-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT21189200
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: