Provider Demographics
NPI:1518725852
Name:CHILD, ALEATHA
Entity Type:Individual
Prefix:MRS
First Name:ALEATHA
Middle Name:
Last Name:CHILD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 N 900 E
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2740
Mailing Address - Country:US
Mailing Address - Phone:801-645-7930
Mailing Address - Fax:
Practice Address - Street 1:136 N 900 E
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-2740
Practice Address - Country:US
Practice Address - Phone:801-645-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician