Provider Demographics
NPI:1699203398
Name:STARR, JORDACHE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JORDACHE
Middle Name:
Last Name:STARR
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:JORDACHE
Other - Middle Name:
Other - Last Name:LEIKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:2299 E HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-6292
Mailing Address - Country:US
Mailing Address - Phone:801-651-0566
Mailing Address - Fax:
Practice Address - Street 1:2299 E HORIZON DR
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-6292
Practice Address - Country:US
Practice Address - Phone:801-651-0566
Practice Address - Fax:801-651-0566
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10322092-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst