MEDICARE: ASPEN BULLARD RBT

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-17-35219	UT

General Provider Information

NPI Number	:	1720517931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASPEN BULLARD RBT

Provider Business Mailing Address
First Line	:	1443 W 800 N STE 210
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84057-2875
Country	:	US
Telephone Number	:	801-655-4950
Fax Number	:

Provider Business Practice Location Address
First Line	:	4933 S 1500 W STE 110
Second Line	:
City	:	RIVERDALE
State	:	UT
Zip	:	84405-7738
Country	:	US
Telephone Number	:	801-820-6420
Fax Number	:

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

Provider Enumeration Date	:	06/09/2017
Last Update Date	:	10/18/2024

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Directions to “ ASPEN BULLARD RBT” Practice Location

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