Individual
ELLA SUPRISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6910 S HIGHLAND DR, COTTONWOOD HEIGHTS, UT 84121-3060
(800) 434-8923
Mailing address
928 W 300 N, PROVO, UT 84601-2513
(801) 362-6352
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/20/2020
Last updated
02/20/2020
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