Provider Demographics
NPI:1194184689
Name:SWIFT, KIRSTEN MICHELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MICHELLE
Last Name:SWIFT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1194 W SOUTH JORDAN PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5508
Mailing Address - Country:US
Mailing Address - Phone:801-302-3801
Mailing Address - Fax:801-302-7248
Practice Address - Street 1:1194 W SOUTH JORDAN PKWY STE B
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5508
Practice Address - Country:US
Practice Address - Phone:801-302-3801
Practice Address - Fax:801-302-7248
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10283598-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst