MEDICARE: BLUE GEMS ABA THERAPY UT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1083482988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE GEMS ABA THERAPY UT LLC

Provider Business Mailing Address
First Line	:	9980 S 300 W STE 200
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-3654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9980 S 300 W STE 200
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-3654
Country	:	US
Telephone Number	:	801-466-2573
Fax Number	:	617-340-3371

Authorized Official
Title or Position	:	CEO
Name	:	DAVID WOLF
Credential	:
Telephone Number	:	617-297-7998

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	06/01/2026

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