Individual
LACEY ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
4058 W SHADY PLUM WAY, SOUTH JORDAN, UT 84095-3908
(801) 735-3252
Mailing address
4058 W SHADY PLUM WAY, SOUTH JORDAN, UT 84095-3908
(801) 735-3252
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
11312885
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271872788003
—
UT
Enumeration date
02/04/2014
Last updated
02/04/2014
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