Healthcare Provider Details

I. General information

NPI: 1225406051
Provider Name (Legal Business Name): BX REDIRECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 03/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7456 S 1740 E
SOUTH WEBER UT
84405-6636
US

IV. Provider business mailing address

7456 S 1740 E
SOUTH WEBER UT
84405-6636
US

V. Phone/Fax

Practice location:
  • Phone: 801-923-8773
  • Fax:
Mailing address:
  • Phone: 801-923-8773
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANDRA KAYE PIPKIN
Title or Position: OWNER/CEO
Credential: M.ED., BCBA
Phone: 801-923-8773