Provider Demographics
NPI:1356659460
Name:ASIAN ASSOCIATION OF UTAH
Entity Type:Organization
Organization Name:ASIAN ASSOCIATION OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BONELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-467-6060
Mailing Address - Street 1:1588 MAJOR ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1588 MAJOR ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-1631
Practice Address - Country:US
Practice Address - Phone:801-467-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT16713252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency