Healthcare Provider Details

I. General information

NPI: 1205583531
Provider Name (Legal Business Name): AUSTIN ERICHSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUSTIN SKELLENGER

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 W 9000 S STE 200
WEST JORDAN UT
84088-5729
US

IV. Provider business mailing address

986 W 9000 S STE 200
WEST JORDAN UT
84088-5729
US

V. Phone/Fax

Practice location:
  • Phone: 385-354-5250
  • Fax:
Mailing address:
  • Phone: 385-354-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12677785-2506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: