Provider Demographics
NPI:1639662133
Name:GANDY, JOSHUA SCOTT
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SCOTT
Last Name:GANDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 W 1720 N APT 213
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:575-704-9180
Mailing Address - Fax:
Practice Address - Street 1:1875 S GENEVA RD, OREM, UT 84508
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:85508
Practice Address - Country:US
Practice Address - Phone:801-437-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician