Provider Demographics
NPI:1720787666
Name:BUCHANAN, ADALEE (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:ADALEE
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12637 S 265 W STE 300
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5403
Mailing Address - Country:US
Mailing Address - Phone:801-998-8428
Mailing Address - Fax:
Practice Address - Street 1:12637 S 265 W STE 300
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5403
Practice Address - Country:US
Practice Address - Phone:801-998-8428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTBACB723022103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst