Individual
KYLIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
220 N 1200 E STE 102, LEHI, UT 84043-5863
(801) 655-4950
Mailing address
1443 W 800 N, OREM, UT 84057-2875
(435) 655-4950
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
13117625-2506
UT
106S00000X
Behavior Technician
—
—
Other
Enumeration date
01/22/2020
Last updated
12/14/2022
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