MEDICARE: SHANELLE CRIPPS

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

General Provider Information

NPI Number	:	1689125585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANELLE CRIPPS

Provider Business Mailing Address
First Line	:	1063 E 300 S # A
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2523
Country	:	US
Telephone Number	:	435-640-7520
Fax Number	:	888-261-6694

Provider Business Practice Location Address
First Line	:	1063 E 300 S # A
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2523
Country	:	US
Telephone Number	:	435-640-7520
Fax Number	:	888-261-6694

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

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	10/17/2016

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Directions to “ SHANELLE CRIPPS ” Practice Location

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