MEDICARE: GILLIAN LORENC

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	RBT-24-383510	MO

General Provider Information

NPI Number	:	1508713173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILLIAN LORENC

Provider Business Mailing Address
First Line	:	2825 E COTTONWOOD PKWY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-7055
Country	:	US
Telephone Number	:	801-448-6195
Fax Number	:

Provider Business Practice Location Address
First Line	:	2825 E COTTONWOOD PKWY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-7055
Country	:	US
Telephone Number	:	801-448-6195
Fax Number	:

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

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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Directions to “ GILLIAN LORENC ” Practice Location

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