Individual provider Active NPI

Breanna Stewart

  • Behavior Technician
  • Riverdale, UT
National Provider Identifier
1154067197
Registry record updated May 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
1-17-27675 Issued in UT
Practice address
4933 S 1500 W Ste 210
Riverdale, UT 84405-7738
Phone
(801) 739-5355
NPI assigned
May 11, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X 1-17-27675 UT Primary

Addresses

Primary practice location

4933 S 1500 W Ste 210
Riverdale, UT 84405-7738

Mailing address

1443 W 800 N Ste 103
Orem, UT 84057-2878
Phone (801) 739-5355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Chrysalis Utah, LLC PastSince May 16, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652227200000",
    "number": "1154067197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1443 W 800 N STE 103",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840572878",
            "telephone_number": "801-739-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4933 S 1500 W STE 210",
            "city": "RIVERDALE",
            "state": "UT",
            "postal_code": "844057738",
            "telephone_number": "801-739-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "BREANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-11",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "UT",
            "license": "1-17-27675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.