Individual
SHASTA WESTERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2940 N CHURCH ST STE 303, LAYTON, UT 84040-6617
(801) 935-4171
Mailing address
5528 S 7500 W, HOOPER, UT 84315-9746
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
110211632506
UT
106E00000X
Assistant Behavior Analyst
—
—
Other
Enumeration date
05/17/2018
Last updated
10/29/2019
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