Provider Demographics
NPI:1023541851
Name:EDENS, ALEXANDERIA LYN (RBT)
Entity Type:Individual
Prefix:
First Name:ALEXANDERIA
Middle Name:LYN
Last Name:EDENS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 W 800 N STE 103
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2878
Mailing Address - Country:US
Mailing Address - Phone:801-655-4950
Mailing Address - Fax:
Practice Address - Street 1:448 E WINCHESTER ST
Practice Address - Street 2:SUITE 200, COMMERCE PARK BUILDING #4
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7591
Practice Address - Country:US
Practice Address - Phone:801-280-0413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-08
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician