MEDICARE: ERICA PATRICIA ANDERSON

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	103K00000X	Behavior Analyst	NA	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649872649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA PATRICIA ANDERSON

Provider Business Mailing Address
First Line	:	1234 S 580 W
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84058-3321
Country	:	US
Telephone Number	:	516-301-8516
Fax Number	:	--

Provider Business Practice Location Address
First Line	:	69010 HIGHLAND DR #1, COTTONWOOD HEIGHTS, UT 84121
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-0000
Country	:	US
Telephone Number	:	801-935-4171
Fax Number	:	--

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

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	11/13/2020

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Directions to “ ERICA PATRICIA ANDERSON ” Practice Location

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