Organization
RE THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALYCEN DECOSTA CCC-SLP (OWNER)
(801) 210-9319
Entity
Organization
Contact information
Practice address
727 S MAIN ST, SPANISH FORK, UT 84660-2449
(801) 210-9319
(801) 210-2090
Mailing address
727 S MAIN ST, SPANISH FORK, UT 84660-2449
(801) 210-9319
(801) 210-2090
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
05/15/2018
Last updated
05/15/2018
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