Healthcare Provider Details

I. General information

NPI: 1619889367
Provider Name (Legal Business Name): OPEN DOOR AUTISM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8177 S HIGH SUMMIT CIR
WEST JORDAN UT
84088-5936
US

IV. Provider business mailing address

8177 S HIGH SUMMIT CIR
WEST JORDAN UT
84088-5936
US

V. Phone/Fax

Practice location:
  • Phone: 801-410-0322
  • Fax:
Mailing address:
  • Phone: 801-410-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KAILEE WELLS
Title or Position: FOUNDER
Credential:
Phone: 801-819-9862