Grace Tidwell
Behavior Technician in Taylorsville, UT. Individual provider (NPI-1).
NPI number1760106348
StatusActive
Last updated in NPPESSep 28, 2022
Details
- NPI
- 1760106348
- Entity type
- Individual (NPI-1)
- Name
- Grace Tidwell
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Sep 28, 2022
- Certification date
- Sep 28, 2022
- Last updated
- Sep 28, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
5558 S 1900 WTaylorsville, UT 84129-9007
Phone 801-255-5131
Mailing address
6013 S Redwood RdTaylorsville, UT 84123-5220
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