Provider Demographics
NPI:1457748923
Name:LILINO, LESLIE L (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:L
Last Name:LILINO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 E 1600 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2748
Mailing Address - Country:US
Mailing Address - Phone:385-208-0538
Mailing Address - Fax:
Practice Address - Street 1:262 E 1600 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2748
Practice Address - Country:US
Practice Address - Phone:385-208-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4745929-2506103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst