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NPI Code Detail

MEDICARE: CARISSA DUDLEY

MEDICARE: CARISSA DUDLEY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1205566551
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARISSA DUDLEY
Provider Business Mailing Address
First Line : 30092 OLD LINCOLN HWY
Second Line :
City : WANSHIP
State : UT
Zip : 84017-9607
Country : US
Telephone Number : 435-671-6328
Fax Number :
Provider Business Practice Location Address
First Line : 8031 S 700 E
Second Line :
City : SANDY
State : UT
Zip : 84070-0555
Country : US
Telephone Number : 385-695-2203
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2022
Last Update Date : 06/10/2022

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Directions to “ CARISSA DUDLEY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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