Provider Demographics
NPI:1184430928
Name:HAMBLIN, DYLLAN REED (BCABA, LABA)
Entity type:Individual
Prefix:
First Name:DYLLAN
Middle Name:REED
Last Name:HAMBLIN
Suffix:
Gender:M
Credentials:BCABA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4875 W 11000 N
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-8844
Mailing Address - Country:US
Mailing Address - Phone:385-201-6078
Mailing Address - Fax:
Practice Address - Street 1:401 S 850 E STE B3
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4112
Practice Address - Country:US
Practice Address - Phone:801-642-2173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0-23-14315106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst