Individual
LILLIAN BOB ADOLPHSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA-D
Contact information
Practice address
1789 E LOGAN AVE, SALT LAKE CITY, UT 84108-2629
(801) 550-3546
Mailing address
1789 E LOGAN AVE, SALT LAKE CITY, UT 84108-2629
(801) 550-3546
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-11-8304
—
103K00000X
Behavior Analyst
800311-2506
UT
104100000X
Social Worker
311800-3503
UT
146M00000X
Intermediate Emergency Medical Technician
2022037088
UT
Other
Enumeration date
04/30/2012
Last updated
09/22/2022
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