Individual
MAKENZIE SIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA, LBA
Contact information
Practice address
1870 N MAIN ST STE 206, CEDAR CITY, UT 84721-7741
(801) 255-5131
Mailing address
6013 S. REDWOOD RD., TAYLORSVILE, UT 84123
(801) 255-5131
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
10156889-2506
UT
Other
Enumeration date
04/24/2015
Last updated
04/05/2022
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