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NPI Code Detail

MEDICARE: JANESSA MARIE EVERETT LUNDQUIST BCBA

MEDICARE: JANESSA MARIE EVERETT LUNDQUIST BCBA
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst8692390-2506UT

General Provider Information

NPI Number : 1780262444
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANESSA MARIE EVERETT LUNDQUIST BCBA
Provider Business Mailing Address
First Line : 1875 S GENEVA RD
Second Line :
City : OREM
State : UT
Zip : 84058-2217
Country : US
Telephone Number : 801-437-0490
Fax Number :
Provider Business Practice Location Address
First Line : 12055 S 700 E
Second Line :
City : DRAPER
State : UT
Zip : 84020-9746
Country : US
Telephone Number : 775-232-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2021
Last Update Date : 09/23/2024

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Directions to “ JANESSA MARIE EVERETT LUNDQUIST BCBA” Practice Location

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