NPI 1568220333

Brocken D Larson, BCBALBA

Practitioner Behavior Analyst South Jordan, UT

Practice location

Address: 10404 S 1055 W, South Jordan, UT 84095-1514
Phone: (801) 855-9110
Mailing address: 191 W 425 S, Ogden, UT 84404-7349

Registered specialties

Behavior Analyst Primary

Behavioral Health & Social Service Providers Taxonomy 103K00000X Licence 12068508-2506 (UT)

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Registry record

NPI: 1568220333
Entity type: Individual
Sex (as registered): Male
NPI issued: 7 Mar 2024
Record last updated: 7 Mar 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.