MEDICARE: QUANTAVIOUS GOLETTE

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	:	1952233215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUANTAVIOUS GOLETTE

Provider Business Mailing Address
First Line	:	955 COUNTRY HILLS DR
Second Line	:
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-2477
Country	:	US
Telephone Number	:	903-701-6317
Fax Number	:

Provider Business Practice Location Address
First Line	:	1295 S STATE ST
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-1600
Country	:	US
Telephone Number	:	385-290-0027
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/02/2026

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Directions to “ QUANTAVIOUS GOLETTE ” Practice Location

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