Healthcare Provider Details

I. General information

NPI: 1609751825
Provider Name (Legal Business Name): ADDISON PICKERING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 N BROADWAY ST STE 101
TOOELE UT
84074-2244
US

IV. Provider business mailing address

96 CHURCH ST
GRANTSVILLE UT
84029-9342
US

V. Phone/Fax

Practice location:
  • Phone: 801-771-0273
  • Fax:
Mailing address:
  • Phone: 435-720-8651
  • 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: