Individual
ICELLE MARIE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6910 S HIGHLAND DR STE 1, COTTONWOOD HEIGHTS, UT 84121-3061
(801) 935-4171
(801) 935-4946
Mailing address
208 N STATE ST APT 2, SALT LAKE CITY, UT 84103-6205
(847) 370-3506
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/29/2020
Last updated
11/29/2020
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