MEDICARE: JAYDALE LOGAN HANSEN

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	BACB1387936	UT

General Provider Information

NPI Number	:	1255288122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYDALE LOGAN HANSEN

Provider Business Mailing Address
First Line	:	986 W 9000 S STE 200
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-5729
Country	:	US
Telephone Number	:	385-354-5250
Fax Number	:

Provider Business Practice Location Address
First Line	:	986 W 9000 S STE 200
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-5729
Country	:	US
Telephone Number	:	385-354-5250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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Directions to “ JAYDALE LOGAN HANSEN ” Practice Location

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