Provider Demographics
NPI:1073331617
Name:ANDERSON, HEATHER (BCBA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANDERSON
Other - Last Name:LOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3056 N BEND LN
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-7332
Mailing Address - Country:US
Mailing Address - Phone:435-881-2480
Mailing Address - Fax:
Practice Address - Street 1:3056 N BEND LN
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-7332
Practice Address - Country:US
Practice Address - Phone:435-881-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1-22-60507103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst