Basic Information
| Provider Information | |||||||||
| NPI: | 1306206719 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOYLE | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | RAELYN | ||||||||
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| Credential: | MA, BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1959 N 350 W | ||||||||
| Address2: | |||||||||
| City: | SUNSET | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840153513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373536166 | ||||||||
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| Practice Location | |||||||||
| Address1: | 209 E GORDON AVE | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840412341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012001574 | ||||||||
| FaxNumber: | 8015135608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2016 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 10432335-2506 | UT | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 222Q00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.