Healthcare Provider Details

I. General information

NPI: 1801484167
Provider Name (Legal Business Name): EMMA NELSON BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 W 7800 S
WEST JORDAN UT
84088-4025
US

IV. Provider business mailing address

1970 W 7800 S
WEST JORDAN UT
84088-4025
US

V. Phone/Fax

Practice location:
  • Phone: 801-506-6695
  • Fax:
Mailing address:
  • Phone: 801-506-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number14292658-2506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: