MEDICARE: NATALIE INNES CLIFTEN 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
1	103K00000X	Behavior Analyst	0082510	UT

General Provider Information

NPI Number	:	1811298276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE INNES CLIFTEN BCBA

Provider Business Mailing Address
First Line	:	28 E 2100 S
Second Line	:	#116
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-2329
Country	:	US
Telephone Number	:	801-918-4710
Fax Number	:	801-505-4639

Provider Business Practice Location Address
First Line	:	9980 S 300 W STE 200
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-3654
Country	:	US
Telephone Number	:	801-466-2573
Fax Number	:	617-213-2381

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

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	09/10/2024

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