Healthcare Provider Details

I. General information

NPI: 1083461925
Provider Name (Legal Business Name): UTAH APPLIED BEHAVIOR ANALYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 N MAPLE LEAF DR
SPANISH FORK UT
84660-6145
US

IV. Provider business mailing address

223 W COUGAR BLVD STE 412
PROVO UT
84604-2546
US

V. Phone/Fax

Practice location:
  • Phone: 619-787-3882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KRISTIAN GIORDANO
Title or Position: MANAGING MEMBER
Credential:
Phone: 619-787-3882