MEDICARE: ALLYSON NICOLE MOZNETT

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	:	1780271726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON NICOLE MOZNETT

Provider Business Mailing Address
First Line	:	2966 S 200 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-3864
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2966 S 200 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-3864
Country	:	US
Telephone Number	:	949-412-3849
Fax Number	:

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

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	12/23/2020

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Directions to “ ALLYSON NICOLE MOZNETT ” Practice Location

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