Provider Demographics
NPI:1780262444
Name:LUNDQUIST, JANESSA MARIE EVERETT (BCBA)
Entity type:Individual
Prefix:
First Name:JANESSA
Middle Name:MARIE EVERETT
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 S GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-2217
Mailing Address - Country:US
Mailing Address - Phone:801-437-0490
Mailing Address - Fax:
Practice Address - Street 1:12055 S 700 E
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9746
Practice Address - Country:US
Practice Address - Phone:775-232-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
UT8692390-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician