Provider Demographics
NPI:1659972354
Name:TIRADO, ROSE (RBT)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:TIRADO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 S 300 E
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-9607
Mailing Address - Country:US
Mailing Address - Phone:801-898-7537
Mailing Address - Fax:
Practice Address - Street 1:207 E GORDON AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2375
Practice Address - Country:US
Practice Address - Phone:385-305-7499
Practice Address - Fax:801-513-5608
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician