Provider Demographics
NPI:1710493283
Name:MERRITT, DANIELLE JEANNE (BCBA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JEANNE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:JEANNE
Other - Last Name:STOELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:919 CALLIE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-0165
Mailing Address - Country:US
Mailing Address - Phone:801-336-7406
Mailing Address - Fax:
Practice Address - Street 1:919 CALLIE CT
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-0165
Practice Address - Country:US
Practice Address - Phone:801-336-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3434312506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst