Ifan Cassandra Poulsen

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

6910 S Highland Dr Ste 1
Cottonwood Heights, UT 84121-3061

Phone

(801) 935-4171

NPI assigned

Nov 19, 2019

Last updated

Oct 25, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1225674872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 WEST 1130 S",
            "address_2": "BUILDING B",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840582888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6910 S HIGHLAND DR STE 1",
            "city": "COTTONWOOD HEIGHTS",
            "state": "UT",
            "postal_code": "841213061",
            "telephone_number": "801-935-4171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULSEN",
        "first_name": "IFAN",
        "middle_name": "CASSANDRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-19",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Cottonwood Heights, UT
• Providers in Cottonwood Heights, UT by specialty
• Behavior Analyst in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.