Individual
CASSIDY BROOKE RALPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2512 S 450 E, BOUNTIFUL, UT 84010-4313
(801) 971-5848
Mailing address
2512 S 450 E, BOUNTIFUL, UT 84010-4313
(801) 971-5848
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
213227408
DRIVER LICENSE NUMBER
UT
Enumeration date
06/06/2019
Last updated
06/06/2019
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