Basic Information
| Provider Information | |||||||||
| NPI: | 1073996328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRENNEN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 S 700 E STE 2A | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841022855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3852278653 | ||||||||
| FaxNumber: | 8019354946 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 700 E | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004348923 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2015 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | UT | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.