Individual
NICOLE BURGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
515 S 700 E STE 2A, SLC, UT 84102
(801) 935-4171
(888) 261-6694
Mailing address
515 S 700 E STE 2A, SLC, UT 84102-2855
(801) 935-4171
(888) 261-6694
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
10903149-2506
UT
106E00000X
Assistant Behavior Analyst
109031492507
UT
106S00000X
Behavior Technician
—
—
Other
Enumeration date
01/09/2017
Last updated
10/11/2018
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