Provider Demographics
NPI:1407342058
Name:AIM-AUTISM IN MOTION, CORP
Entity Type:Organization
Organization Name:AIM-AUTISM IN MOTION, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LBA, LCSW
Authorized Official - Phone:801-452-1940
Mailing Address - Street 1:2811 N 2350 W
Mailing Address - Street 2:
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-5177
Mailing Address - Country:US
Mailing Address - Phone:801-452-1940
Mailing Address - Fax:
Practice Address - Street 1:2811 N 2350 W
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-5177
Practice Address - Country:US
Practice Address - Phone:801-452-1940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT74547942506103K00000X
UT745479435011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty